VIRAL ANTIGENS

Abstract

 The present invention relates to RNA constructs capable of encoding antigenic peptides or polypeptides derived from multiple Human Papilloma Virus (HPV) early proteins, and to immunogenic compositions comprising such RNA constructs and a pharmaceutically acceptable carrier. Such RNA constructs and immunogenic compositions are useful in the treatment of persistent HPV infection and low-grade HPV lesions, particularly infections and lesions of human anogenital epithelial tissue, such as cervical epithelia.

Description

FIELD OF THE INVENTION

[0001] The present invention relates to immunogenic RNA constructs and compositions useful in the treatment of persistent HPV infection and low-grade HPV lesions, particularly infections and lesions of human anogenital epithelial tissue, such as cervical epithelia.

BACKGROUND

[0002] Human Papillomavirus (HPV) is a small DNA virus that infects mucosal and/or cutaneous skin and causes multiple disease conditions, including common warts, anogenital warts (condyloma acuminate), and neoplastic conditions of the epithelium (cervical neoplasia, cervical cancer, and other anogenital cancers). Human Papillomavirus (HPV) is a non-enveloped deoxyribonucleic acid (DNA) virus, with a circular genome of double-stranded DNA encoding six early proteins (E1, E2, E4, E5, E6 and E7) and two late proteins (L1 and L2). HPV E1 and E2 proteins are required for replication of the virus. HPV E4 and E5 function in viral assembly and cellular proliferation. HPV E6 induces DNA synthesis and interacts with various cellular proteins and the tumor suppressor, p53. HPV E7 induces cell proliferation and interacts with cell cycle regulators and tumor suppressors, such as pRB. Both E6 and E7 are considered oncogenic due to their capacity to interfere with tumor suppressors and promote malignant transformation. Late proteins L1 and L2 provide viral structural proteins.

[0003] The "early" proteins have regulatory functions, affecting HPV genome replication and transcription, as well as immune modulation and structural modification of infected cells. The E1 protein is required for initiation of viral DNA replication, and is needed for replication and amplification of the viral episome in the nucleus of the infected cell.

[0004] The HPV E1 protein includes an N-terminal regulatory region required for optimal replication in vivo but not in vitro, a DNA Binding Domain, and a C-terminal enzymatic domain (which comprises a minimal oligomerization domain sufficient for self-assembly into hexamers, ATPase activity region capable of unwinding DNA duplexes, and a brace region for assembly and stabilization of the E1 hexamer).

[0005] Regulatory HPV E2 protein plays an accessory role in initiation of DNA replication by activating or repressing transcription. The E2 protein contains a transactivation domain (TAD) important for transcriptional activation/repression and replication; a flexible linker, and a DNA binding dimerization domain (DBD) that affects transcriptional activation / repression and replication.

[0006] HPV E6 protein plays a role in the induction and maintenance of cellular transformation, and acts by stimulating the destruction of host cell regulatory proteins. E6 associates with host cell E6-AP ubiquitin-protein ligase (E6AP) and inactivates tumor suppressors such as TP53 by targeting them to the 26S proteasome for degradation. A PDZ ligand on the C-terminal of the E6 protein interacts with cellular PDZ-containing proteins, which can alter differentiation of cells.

[0007] HPV establish productive infections within the stratified epithelia of the skin, and the mucosal epithelium of the anogenital tract and the oral cavity. HPVs can infect basal cells (the proliferating component of stratified epithelia). After basal cell division, daughter cells typically migrate into the suprabasal compartment and undergo terminal differentiation; HPV infection disturbs or prevents the differentiation of the epithelial cells, but continues to support DNA synthesis and cell proliferation. The circular viral DNA genome, normally harbored in the infected cell as a nuclear plasmid, may become integrated into the host genome, leading to up-regulation of the oncogenes HPV E6 and E7, and a growth advantage over other cells. Studies suggest that HPV E6 and E7 proteins are responsible for the malignant phenotype of cervical carcinoma cells.

[0008] Both E6 and E7 proteins are typically expressed in HPV-carrying anogenital malignant tumors. The progression of low-grade HPV cervical lesions to invasive cancer is associated with the integration of the HPV genome into the host chromosomes, the loss or disruption of E2 expression, and upregulation of E6 and E7 oncogene expression.

[0009] A majority of HPV infections of the cervical epithelium are subclinal and self-resolving within a two-year period. However, persistant infection with high risk HPV types may cause lesions and progress to invasive cancer. Large-scale epidemiological studies have identified infection with high-risk HPV types as the major risk factor for cervical cancer, which is reported to be one of the most common cancers in women worldwide. The risk that an HPV infection will progress to clinical disease varies with the type of HPV. HPV types have been divided into those known to be associated with high-grade cervical intraepithelial neoplasia and cancer, and those not known to be associated with high-grade lesions or cancer.

[0010] There are over 40 types of HPV known to infect the anogenital tract of humans and about 15 high-risk HPV genotypes are causally associated with human cervical cancers.

[0011] Various systems exist for the classification of cervical dysplasia caused by HPV infection, e.g., the Bethesda System (Solomon (1990)) and the Cervical Intraepithelial Neoplasia (CIN) scale (Richart (1990)). Low-grade precursors of cervical cancer are known as CIN grade 1 (CIN scale) or low-grade squamous intraepithelial lesions (LSIL) (Bethesda system); these may progress to high-grade precursors (CIN grades 2 and 3 / high-grade squamous intraepithelial lesions (HSIL)). Additionally, there is evidence that CIN3 can develop directly from infection by certain high-risk HPV types, without a stage of CIN1 or 2 (see, e.g., Winer et al., 2005). The 'grade' of CIN is based on the percentage of cells that are abnormal (dysplastic).

[0012] Studies suggest that many HPV infections become undetectable within 1-2 years. However, the duration of infection appears to be longer for high-risk HPV types compared to low-risk types. A study of longer-term infection with a median follow-up of 5.1 years (Schiffman et al., 2005) showed a longer persistence of HPV 16 compared with other HPV types.

[0013] In cervical HPV infections, the relative frequency of different HPV types varies among the stages of cervical lesion. HPV16 has been found to be twice as prevalent in HSIL than in LSIL, for example. Other HPV types are found more often in LSIL (see WHO/IC summary report, 2010 showing eg. 6.1% prevalence of HPV 66 in LSIL, and 0.4% in Cervical Cancer (CC)). See also IARC Monograph, vol. 90, pp. 193 - 194, Table 26.

[0014] Thus, among the HPV types known to infect human anogenital epithelial tissue, some are associated with a higher risk for progression to cervical cancer, compared to other HPV types. High risk HPV types (hrHPV) include: 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, 82. In invasive cancers caused by HPV, high-risk HPV genomes are frequently integrated into the host genome. Integration of HPV can also be found in high-grade lesions (e.g., grade 2/3 CIN). IARC monograph, p. 441.

[0015] The HPV L1 Open Reading Frame (ORF) is used to distinguish among, and identify new, HPV types, as it is the most conserved region in the HPV genome. A new type is recognized if the complete genome has been cloned and the DNA sequence of the L1 ORF differs by more than 10% from the closest known type. Differences in homology of between 2% and 10% define a subtype and those of less than 2% define a variant. (IARC Monograph Vol. 90, page 52).

[0016] Prophylactic vaccines are designed to prevent infection, and prophylactic HPV vaccines have been developed (see, e.g., FUTURE II Study Group, 2007; Garland et al., 2007). GARDISIL™ 9 (Merck & Co) contains antigenic "late" proteins from nine HPV types (6, 11, 16, 18, 31, 33, 45, 52 and 58). CERVARIX™ (GlaxoSmithKline), contains antigenic "late" proteins from HPV 16 and 18. Both GARDISIL and CERVARIX provide virus-like particles (VLPs) of the HPV major capsid L1 protein. As stated in the current GARDISIL™ prescribing information for the United States, the efficacy of the vaccine is believed to be mediated by humoral responses induced by vaccination. Animal studies further support that the efficacy of HPV L1 VLP vaccines is largely mediated by the development of a humoral immune response.

[0017] A cross-protective effect of prophylactic HPV vaccines has been reported. Wheeler et al. (2012) evaluated the cross-protective efficacy of CERVARIX™ (HPV-16/18 AS04-adjuvanted vaccine) against HPV types other than HPV16 and HPV18. See also Malagon et al. (2012).

[0018] A therapeutic HPV vaccine is one designed for the treatment of HPV infection or related disease, and thus acts to eradicate infected cells, significantly reduce the number of infected cells, decrease the duration of infection, or slow or prevent the progression of low-grade lesions (e.g., CIN1 or LSIL). Once HPV infection has been established, it is considered unlikely that antibodies play a role in eradicating infected cells. Cytotoxic T lymphocytes (CTL) are believed to be the primary effectors of eradication (see, e.g., IARC monograph volume 90, p. 174).

[0019] VLPs can also induce T-cell responses. Vaccination of subjects with HPV 16 VLPs was shown to induce both CD4+ and CD8+ T-cell responses (Pinto et al., 2003; Oh, Y.K. et al., 2004). Herrin et al. report that both CERVARIX™ (HPV16/18) and GARDISIL™ (HPV6/11/16/18) are associated with CD4 T cell responses (Einstein et al., (2011); Herrin et al., (2014)). Chimeric VLPs that contain a linked segment of HPV E7 have been shown to induce specific HLA T cells in humans after in-vitro vaccination (Kaufmann et al., 2001).

[0020] Various live vector-based, peptide/protein-based, nucleic acid-based and whole cell-based therapeutic HPV vaccines targeting HPV E6 and E7 oncoproteins have been assessed (for review, see Lin et al., 2010; Hung et al., 2008).

[0021] Recombinant vaccinia viruses, which are able to carry large inserts and do not persist in the host, have been studied for use as vaccine vectors. However, individuals may have pre-existing immunity to vaccinia virus which reduces the response to the administered vector. A recombinant vaccinia virus expressing the E6 and E7 genes of HPV 16 and 18 was created (Kaufmann et al., 2002). After a single vaccination, four patients developed cytotoxic T cells and eight developed serological responses to the HPV proteins. A recombinant vaccinia virus encoding modified E6 and E7 from HPV 16 and 18 has been tested in patients with vulvar intraepithelial neoplasia (VIN) (Baldwin et al., 2003; Davidson et al., 2003). Davidson et al. (2003) vaccinated 18 women with HPV 16-positive high-grade VIN with a single dose,which resulted in a reduction in the size of the lesion by at least 50% in eight patients. A second vaccination formulation, HPV 16 L2E6E7 fusion protein, has been tested in 10 patients with high-grade VIN. All but one demonstrated HPV 16-specific proliferative T-cell and/or serological responses following vaccination. However, no direct correlation between immunological and clinical responses was seen (Davidson et al., 2004).

[0022] Clinical trials of other viral delivery systems, including recombinant adenoviruses (Tobery et al., 2003), adeno-associated virus (Liu et al., 2000), RNA-based poliovirus (van Kuppeveld et al., 2002) and alphavirus (Velders et al., 2001) vaccines, constructed to express E7 or poly-epitope proteins, have been proposed or initiated.

[0023] Currently there is no effective treatment for persistent cervical HPV infection, LSIL or CIN1. Health care providers may choose to 'wait and watch' HPV infections, causing stress and anxiety in the patient due to the risk of progression to cervical cancer. Accordingly, there is a need for therapeutic treatments directed at persistent cervical HPV infection, or low-grade HPV lesions, particularly when caused by known high risk HPV types.

SUMMARY OF THE INVENTION

[0024] In a first aspect, the present invention provides one or more RNA construct(s) comprising nucleic acid sequences encoding:

• antigenic Human Papillomavirus (HPV) polypeptides from a first HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type, and
• antigenic HPV polypeptides from a second HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type,

and wherein each of said antigenic HPV polypeptides includes at least one T cell epitope, and said nucleic acid sequences are operatively linked to one or more sequences which direct expression of said antigenic HPV polypeptides in a mammalian host cell.

[0025] In one aspect, the invention provides self-replicating RNA molecules comprising the RNA construct(s) as described herein.

[0026] In another aspect, the invention provides DNA molecules encoding the RNA construct(s) or the self-replicating RNA molecule as described herein.

[0027] In another aspect, the invention provides vectors comprising the RNA construct(s), the self-replicating RNA molecule or the DNA molecules as described herein.

[0028] In another aspect, the invention provides an immunogenic composition comprising the RNA construct(s), the self-replicating RNA molecule, the DNA molecule or the vector according to the invention and a pharmaceutically acceptable carrier.

[0029] In another aspect, there is provided the RNA construct(s), the self-replicating RNA molecule, the DNA molecule, the vector or the immunogenic composition according to the invention, for use in therapy.

[0030] In another aspect, there is provided the RNA construct(s), the self-replicating RNA molecule, the DNA molecule, the vector or the immunogenic composition according to the invention, for use in the treatment of an HPV-related condition of the human anogenital tract, selected from infection by HPV such as a high-risk HPV type, and, lesions of the cervical epithelium, such as Cervical Intraepithelial Neoplasia grade 1 (CIN1) and low-grade squamous intraepithelial lesions (LSIL).

[0031] In another aspect, there are provided two or more RNA constructs according to the invention, where the two or more RNA constructs encode at least one antigenic polypeptide from (a) different HPV early proteins, or (b) different HPV types, for use in a method of inducing an immune response in a mammalian subject, wherein the two or more RNA constructs are co-administered.

[0032] In another aspect, there is provided the use of one or more RNA construct(s) or immunogenic composition according to the invention in the manufacture of a medicament for treating an HPV-related condition of the human anogenital tract, selected from infection by a high-risk HPV type, CIN, and LSIL.

[0033] In another aspect, there is provided a method of inducing an immune response in a mammalian subject comprising administering to the subject one or more RNA construct(s) or immunogenic composition according to the invention.

[0034] In another aspect, there is provided a method of treating infection of the human anogenital epithelium by a high-risk HPV type, comprising co-administering to a subject in need of treatment, RNA constructs expressing:

(a) an antigenic polypeptide from each of E1, E2 and E6 from HPV16,

(b) an antigenic polypeptide from each of E1, E2, and E6 from HPV18, and

(c) an antigenic polypeptide sequence from the E2 or E6 protein from no more than six additional HPV types, said additional HPV types selected from the group consisting of HPV31, 33, 45, 52, 58, 56, 51, 39, 35, 59, 68, 73, and 82;

[0035] In another aspect, the invention provides a method of manufacturing an immunogenic composition comprising the steps of combining (i) one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule or vector(s) according to the invention with (ii) a non-viral delivery material, such as a submicron cationic oil-in-water emulsion; a liposome; or a biodegradable polymeric microparticle delivery system; wherein the one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule or vector(s) according to the invention are (A) in physical contact with said non-viral delivery material or (B) packaged in a first container and said non-viral delivery material packaged in a second container.

BRIEF DESCRIPTION OF THE DRAWINGS

[0036] 

Figure 1 - Diagrams of nucleotide insert constructs (A) Gly_E2⁴, (B) Gly_E2³E7² and (C) Gly_E1²E6⁷ Double lines indicate the position of the 5xGly. (Fragments of HPV proteins are not drawn to scale). "Gly" indicates the presence of either the 5xGly linker.

Figure 2 - SAM-HPV constructs. The SAM background consists of VEE TC-83 replicon encoding the viral non-structural proteins 1-4 (nsP1-4), followed by the subgenomic promoter, and a transgene encoding antigenic HPV polypeptides. The empty vector is shown in SEQ ID NO:1.

DESCRIPTION OF THE SEQUENCES

[0037] 

SEQ ID NO:1 - Sequence for empty SAM vector.

SEQ ID NO:2 - E2_SAM insert polypeptide sequence

SEQ ID NO:3 - E2_SAM insert polynucleotide sequence

SEQ ID NO:4 - E2E7_SAM insert polypeptide sequence

SEQ ID NO:5 - E2E7_SAM insert polynucleotide sequence

SEQ ID NO:6 - E1E6_SAM insert polypeptide sequence

SEQ ID NO:7 - E1E6_SAM insert polynucleotide sequence

SEQ ID NO:8 - SAM E2 vector DNA sequence

SEQ ID NO:9 - SAM E2 vector RNA sequence

SEQ ID NO:10 - SAM E2E7 vector DNA sequence

SEQ ID NO:11 - SAM E2E7 vector RNA sequence

SEQ ID NO:12 - SAM E1E6 vector DNA sequence

SEQ ID NO:13 - SAM E1E6 vector DNA sequence

SEQ ID NO:14 - HPV16 - E1 full length sequence

SEQ ID NO:15 - HPV16 - E2 full length sequence

SEQ ID NO:16 - HPV16 - E6 full length sequence

SEQ ID NO:17 - HPV16 - E7 Full length sequence

SEQ ID NO:18 - HPV16 E1 aa 203-622

SEQ ID NO:19 - HPV18 E1 aa 210-629

SEQ ID NO:20 - HPV16 E2 : AA1-201 + GGTGGS linker + aa285-365

SEQ ID NO:21 - HPV 18 E2: AA1-206 + GGTGGS linker + aa286-365

SEQ ID NO:22 - HPV 31 E2: AA1-201 + GGTGGS linker + aa292-372

SEQ ID NO:23 - HPV 33 E2: AA1-201 + GGTGGS linker + aa273-353

SEQ ID NO:24 - HPV45 E2: AA1-208 + GGTGGS linker + aa290-368

SEQ ID NO:25 - HPV52 E2: AA1-201 + GGTGGS linker + aa287-368

SEQ ID NO:26 - HPV58 E2: AA1-201 + GGTGGS linker + aa278-358

SEQ ID NO:27 - HPV 16 E6: aa11-150

SEQ ID NO:28 - HPV 18 E6: aa6-145

SEQ ID NO:29 - HPV 31 E6: aa4-143

SEQ ID NO:30 - HPV 33 E6: aa4-143

SEQ ID NO:31 - HPV 45 E6: aa6-145

SEQ ID NO:32 - HPV 52 E6: aa4-143

SEQ ID NO:33 - HPV 58 E6: aa4-143 SEQ ID NO:34 - HPV 16 E7: aa49-98 + aa7-28, C24G and E26Q substitutions

SEQ ID NO:35 - HPV 18 E7: aa58-105 + aa7-42, C27G and E29Q substitutions

SEQ ID NO:36. 2A sequence (amino acid)

SEQ ID NO:37. 5x Gly Linker

SEQ ID NO:38. linker

DETAILED DESCRIPTION

[0038] The present invention provides RNA constructs capable of encoding HPV peptides useful in inducing a therapeutic immune response to persistent HPV infection, such as HPV infection of the cervical epithelium. The RNA constructs are designed to encode antigenic HPV peptides capable of inducing a cross-reactive immune response in a subject against more than one high-risk HPV type. SAM vectors encoding the antigenic HPV peptides are also provided.

RNA constructs

[0039] In a first aspect, the present invention provides one or more RNA construct(s) comprising nucleic acid sequences encoding:

• antigenic Human Papillomavirus (HPV) polypeptides from a first HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type, and
• antigenic HPV polypeptides from a second HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type,

and wherein each of said antigenic HPV polypeptides includes at least one T cell epitope, and said nucleic acid sequences are operatively linked to one or more sequences which direct expression of said antigenic HPV polypeptides in a mammalian host cell.

[0040] In one embodiment, the nucleic acid sequences encode separate antigenic HPV polypeptides. In a preferred embodiment, the nucleic acid sequences encode antigenic HPV polypeptides that are linked by a peptide linker.

[0041] In a preferred embodiment, the RNA construct(s) do not comprise any nucleic acid sequence encoding an antigenic polypeptide from an HPV Late 1 (L1) protein or an HPV Late 2 (L2) protein.

[0042] In one embodiment, the nucleic acid sequences encoding antigenic HPV polypeptides from the first and second HPV early protein are located on the same RNA construct. In an alternative embodiment, the nucleic acid sequences encoding antigenic HPV polypeptides from the first and second HPV early protein are located on two or more RNA constructs.

[0043] Preferably, the RNA construct(s) according to the invention comprise antigenic polypeptide sequences selected from HPV types HPV16, HPV18, HPV31, HPV33, HPV35, HPV39, HPV45, HPV51, HPV52, HPV56, HPV58, HPV59, HPV68, HPV73 and HPV82.

[0044] In one embodiment, the first HPV early protein is Early 1 (E1), and the second HPV early protein is selected from Early 2 (E2), Early 6 (E6), and Early 7 (E7). In another embodiment, the first HPV early protein is E2, and the second HPV early protein is selected from E1, E6 and E7. In another embodiment, the first HPV early protein is E6, and the second HPV early protein is selected from E1, E2 and E7. In another embodiment, the first HPV early protein is E7, and the second HPV early protein is selected from E1, E2 and E6.

[0045] Preferably, the first HPV early protein is Early 1 (E1). Preferably still, the antigenic HPV polypeptides from E1 include antigenic polypetides from HPV16 E1 and HPV18 E1. Suitably, the antigenic HPV polypeptides from E1 do not include antigenic polypetides from other HPV types.

[0046] Suitably, the RNA construct(s) encode:

• E1 antigenic polypeptides having an amino acid sequence corresponding to amino acids 203-622 of HPV 16 E1 (SEQ ID NO:14), and optionally comprising a Glycine to Aspartic acid substitution at position 482 (G482D), and/or
• E1 antigenic polypeptides having an amino acid sequence corresponding to amino acids 210-629 of HPV 18 E1, and optionally comprising a Glycine to Aspartic acid substitution at position 489 (G489D).

[0047] In a preferred embodiment, the RNA construct(s) according to the invention further comprise a nucleic acid sequence encoding antigenic HPV polypeptides from a third HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity, and each antigenic HPV polypeptide includes at least one T cell epitope. Suitably, the first HPV early protein is E1, the second HPV early protein is E2 and the third HPV early protein is E6. Preferably, the nucleic acid sequences encode antigenic polypeptides from HPV16 E1, HPV18 E1, HPV16 E2, HPV18 E2, HPV16 E6 and HPV18 E6. In one embodiment, the nucleic acid sequences also encode antigenic polypeptides from HPV31 E2, HPV33 E2, HPV45 E2, HPV52 E2, HPV58 E2, HPV31 E6, HPV33 E6, HPV45 E6, HPV52 E6, HPV52 E6 and HPV58 E6.

[0048] Suitably, the RNA construct(s) according to the invention further comprise a nucleic acid sequence encoding antigenic HPV polypeptides from a fourth HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity, and each antigenic HPV polypeptide sequence includes at least one T cell epitope. Preferably, the first HPV early protein is E1, the second HPV early protein is E2, the third HPV early protein is E6 and the fourth HPV early protein is E7. Preferably, the nucleic acid sequences encode antigenic polypeptides from HPV16 E1, HPV18 E1, HPV16 E2, HPV18 E2, HPV16 E6, HPV18 E6, HPV16 E7 and HPV18 E7. In one embodiment, the nucleic acid sequences also encode antigenic polypeptides from HPV31 E2, HPV33 E2, HPV45 E2, HPV52 E2, HPV58 E2, HPV31 E6, HPV33 E6, HPV45 E6, HPV52 E6, HPV52 E6 and HPV58 E6.

[0049] According to one embodiment of the RNA construct(s) according to the invention, the nucleic acid sequences encode one or more polypeptides that are at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from the group of SEQ ID NO:18 to SEQ ID NO:35.

[0050] In one embodiment, the RNA construct(s) comprise:

• an RNA construct comprising a nucleic acid sequence encoding a polypeptide that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:2,
• an RNA construct comprising a nucleic acid sequence encoding a polypeptide that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:4, and
• an RNA construct comprising a nucleic acid sequence encoding a polypeptide that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:6.

[0051] Suitably, the RNA construct(s) comprise:

• an RNA construct comprising a nucleic acid sequence encoding a polypeptide corresponding to SEQ ID NO:2,
• an RNA construct comprising a nucleic acid sequence encoding a polypeptide corresponding to SEQ ID NO:4, and
• an RNA construct comprising a nucleic acid sequence encoding a polypeptide corresponding to SEQ ID NO:6.

[0052] In one embodiment, the RNA construct(s) comprise:

• an RNA construct comprising a nucleic acid sequence that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:3,
• an RNA construct comprising a nucleic acid sequence that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:5, and
• an RNA construct comprising a nucleic acid sequence that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to SEQ ID NO:7.

[0053] Suitably, the RNA construct(s) comprise:

• an RNA construct comprising a nucleic acid sequence corresponding to SEQ ID NO:3,
• an RNA construct comprising a nucleic acid sequence corresponding to SEQ ID NO:5, and
• an RNA construct comprising a nucleic acid sequence corresponding to SEQ ID NO:7.

[0054] In one embodiment of the RNA construct(s) according to the invention, the nucleic acid sequence does not encode any antigenic polypeptide having at least 70% identity to an HPV Early protein from a non-high risk HPV type.

[0055] In one embodiment, the sequence of the RNA construct(s) is codon optimized.

[0056] In one aspect, the invention provides self-replicating RNA molecules comprising the RNA construct(s) as described herein.

[0057] In one aspect, the invention provides DNA molecules encoding the RNA construct(s) or the self-replicating RNA molecule as described herein.

[0058] In one aspect, the invention provides vectors comprising the RNA construct(s), the self-replicating RNA molecule or the DNA molecules as described herein.

Immunogenic compositions

[0059] In one aspect, the invention provides an immunogenic composition comprising the RNA construct(s), the self-replicating RNA molecule, the DNA molecule or the vector according to the invention and a pharmaceutically acceptable carrier.

[0060] In one embodiment, the immunogenic composition comprises two or three RNA construct(s) according to the invention.

[0061] In one embodiment, the immunogenic composition further comprises a non-viral delivery material, such as a submicron cationic oil-in-water emulsion; a liposome; or a biodegradable polymeric microparticle delivery system.

[0062] In one embodiment, the immunogenic composition further comprises an adjuvant. Suitable adjuvants for use in the present invention include metal salts, saponins, cytokines, monophosphoryl lipid A, 3-de-O-acylated monophosphoryl lipid A (3D-MPL), Toll-like receptor (TLR) agonists, and immunostimulatory oligonucleotides containing unmethylated CpG dinucleotides.

[0063] In one embodiment, the immunogenic composition further comprises at least one isolated antigenic HPV polypeptide from HPV E1, E2, E6 or E7, from a high-risk HPV type.

[0064] In one embodiment, the immunogenic composition does not comprise any antigenic polypeptides from Late (L) HPV proteins.

Use in therapy and methods of treatment

[0065] In another aspect, there is provided the RNA construct(s), the self-replicating RNA molecule, the DNA molecule, the vector or the immunogenic composition according to the invention, for use in therapy.

[0066] In another aspect, there is provided the RNA construct(s), the self-replicating RNA molecule, the DNA molecule, the vector or the immunogenic composition according to the invention, for use in the treatment of an HPV-related condition of the human anogenital tract, selected from infection by HPV such as a high-risk HPV type, and, lesions of the cervical epithelium, such as Cervical Intraepithelial Neoplasia grade 1 (CIN1) and low-grade squamous intraepithelial lesions (LSIL).

[0067] In another aspect, there are provided two or more RNA constructs according to the invention, where the two or more RNA constructs encode at least one antigenic polypeptide from (a) different HPV early proteins, or (b) different HPV types, for use in a method of inducing an immune response in a mammalian subject, wherein the two or more RNA constructs are co-administered.

[0068] Suitably, the two or more RNA constructs together encode antigenic polypeptides from the E2 protein and E6 protein from each of HPV16, 18, 31, 33, 45, 52 and 58, and antigenic polypeptides from the E1 protein and the E7 protein from each of HPV16 and 18.

[0069] In a preferred embodiment, the method of inducing an immune response is a method of treatment of HPV-related disease of the human anogenital tract selected from infection by HPV such as a high-risk HPV type, and, lesions of the cervical epithelium, such as Cervical Intraepithelial Neoplasia grade 1 (CIN1) and low-grade squamous intraepithelial lesions (LSIL).

[0070] Suitably, the method comprises subsequent administration of further RNA construct(s) according to the invention.

[0071] Suitably, the method further comprises co-administration with the two or more RNA constructs, of one or more isolated antigenic polypeptide(s) from at least one HPV early protein from a high-risk HPV type, optionally with an adjuvant.

[0072] Suitably, the method further comprises subsequent administration of one or more isolated antigenic polypeptide(s) from at least one HPV early protein from a high-risk HPV type, and an adjuvant.

[0073] In another aspect, there is provided the use of one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule(s), vector(s) or immunogenic composition according to the invention in the manufacture of a medicament for treating an HPV-related condition of the human anogenital tract, selected from infection by a high-risk HPV type, CIN, and LSIL.

[0074] In another aspect, there is provided a method of inducing an immune response in a mammalian subject comprising administering to the subject one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule(s), vector(s) or immunogenic composition according to the invention.

[0075] In another aspect, there is provided a method of treating infection of the human anogenital epithelium by a high-risk HPV type, comprising co-administering to a subject in need of treatment, RNA constructs expressing:

(a) an antigenic polypeptide from each of E1, E2 and E6 from HPV16,

(b) an antigenic polypeptide from each of E1, E2, and E6 from HPV18, and

(c) an antigenic polypeptide sequence from the E2 or E6 protein from no more than six additional HPV types, said additional HPV types selected from the group consisting of HPV31, 33, 45, 52, 58, 56, 51, 39, 35, 59, 68, 73, and 82;

where said antigenic polypeptides include at least one sequence having at least 70% sequence identity to an Early protein from each of HPV31, 33, 45, 52, 58, 56, 51, 39, 35, 59, 68, 73, and 82; and wherein administration induces specific cell-mediated immunity against HPV16 and HPV18, and cross-reactive cell-mediated immunity against at least one of the additional HPV types that was not selected in step (c).

[0076] Preferably, the RNA construct(s) express antigenic polypeptides from both the E2 and E6 protein from said no more than six additional HPV types. Suitably, the RNA construct(s) express antigenic polypeptides from both the E2 and E6 proteins of HPV31, 33, 45, 52 and 58, wherein administration induces cross-reactive cell-mediated immunity against HPV35. Suitably, the antigenic polypeptides are co-administered using one or more self-replicating RNA (or "SAM") vectors. In one embodiment, the infection of the human anogenital epithelium by a high-risk HPV type has resulted in lesions of the cervical epithelium, such as lesions identified as CIN1 or LSIL. In one embodiment, no antigenic polypeptides from HPV Late proteins are co-administered.

[0077] In another aspect, the invention provides a method of manufacturing an immunogenic composition comprising the steps of combining (i) one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule or vector(s) according to the invention with (ii) a non-viral delivery material, such as a submicron cationic oil-in-water emulsion; a liposome; or a biodegradable polymeric microparticle delivery system; wherein the one or more RNA construct(s), self-replicating RNA molecule(s), DNA molecule or vector(s) according to the invention (A) in physical contact with said non-viral delivery material or (B) packaged in a first container and said non-viral delivery material packaged in a second container.

RNA constructs

[0078] RNA constructs according to the invention can take various forms (e.g. single-stranded, double-stranded, vectors etc.). RNA constructs may be circular or branched, but will preferably be linear.

[0079] The RNA constructs used herein are preferably provided in purified or substantially purified form i.e. substantially free from other nucleic acids (e.g. free from naturally-occurring nucleic acids), particularly from other viral or host cell nucleic acids, generally being at least about 50% pure (by weight), and usually at least about 90% pure.

[0080] RNA constructs may be prepared in many ways e.g. by chemical synthesis in whole or in part, by digesting longer nucleic acids using nucleases (e.g. restriction enzymes), by joining shorter nucleic acids or nucleotides (e.g. using ligases or polymerases), from genomic or cDNA libraries, etc.

[0081] The term "nucleic acid" in general means a polymeric form of nucleotides of any length, which contain deoxyribonucleotides, ribonucleotides, and/or their analogs. It includes DNA, RNA, DNA/RNA hybrids. It also includes DNA or RNA analogs, such as those containing modified backbones (e.g. peptide nucleic acids (PNAs) or phosphorothioates) or modified bases. The RNA constructs of the present disclosure may or may not have a 5' cap.

[0082] The RNA constructs herein comprise an RNA sequence which encodes the antigenic HPV polypeptides as described herein. Typically, the RNA constructs of the invention will be in recombinant form, i. e. a form which does not occur in nature. For example, the nucleic acid may comprise one or more heterologous RNA sequences (e.g. a sequence encoding another antigen and/or a control sequence such as an internal ribosome entry site) in addition to the sequence encoding at least one HPV antigen or the HPV transgene. The RNA construct may be part of a vector i. e. part of a nucleic acid construct designed for transduction/transfection of one or more cell types. Vectors may be, for example, "expression vectors" which are designed for expression of a nucleotide sequence in a host cell, or "viral vectors" which are designed to result in the production of a recombinant virus or virus-like particle. In another embodiment, the RNA construct may be a messenger RNA.

[0083] Alternatively, or in addition, the sequence or chemical structure of the RNA constructs may be modified compared to a naturally-occurring sequence which encodes the antigenic HPV polypeptides. The sequence of the RNA constructs may be modified, e.g. to increase the efficacy of expression or replication of the RNA construct, or to provide additional stability or resistance to degradation.

[0084] The RNA construct encoding the antigenic HPV polypeptides described above may be codon optimized. By "codon optimized" is intended modification with respect to codon usage that may increase translation efficacy and/or half- life of the nucleic acid. A poly A tail (e.g., of about 30 adenosine residues or more) may be attached to the 3' end of the RNA to increase its half-life. The 5' end of the RNA may be capped with a modified ribonucleotide with the structure m7G (5') ppp (5') N (cap 0 structure) or a derivative thereof, which can be incorporated during RNA synthesis or can be enzymatically engineered after RNA transcription (e.g., by using Vaccinia Virus Capping Enzyme (VCE) consisting of mRNA triphosphatase, guanylyl- transferase and guanine-7-methytransferase, which catalyzes the construction of N7-monomethylated cap 0 structures). Cap 0 structure plays an important role in maintaining the stability and translational efficacy of the RNA molecule. The 5' cap of the RNA molecule may be further modified by a 2 '-O-Methyltransferase which results in the generation of a cap 1 structure (m7Gppp [m2 '-O] N), which may further increases translation efficacy.

[0085] The nucleic acids may comprise one or more nucleotide analogs or modified nucleotides. As used herein, "nucleotide analog" or "modified nucleotide" refers to a nucleotide that contains one or more chemical modifications (e.g., substitutions) in or on the nitrogenous base of the nucleoside (e.g. cytosine (C), thymine (T) or uracil (U)), adenine (A) or guanine (G)). A nucleotide analog can contain further chemical modifications in or on the sugar moiety of the nucleoside (e.g., ribose, deoxyribose, modified ribose, modified deoxyribose, six-membered sugar analog, or open-chain sugar analog), or the phosphate. The preparation of nucleotides and modified nucleotides and nucleosides are well-known in the art, see the following references: US Patent Numbers 4373071, 4458066, 4500707, 4668777, 4973679, 5047524, 5132418, 5153319, 5262530, 5700642. Many modified nucleosides and modified nucleotides are commercially available.

[0086] Modified nucleobases which can be incorporated into modified nucleosides and nucleotides and be present in the RNA molecules include: m5C (5-methylcytidine), m5U (5-methyluridine), m6A (N6-methyladenosine), s2U (2-thiouridine), Um (2'-0-methyluridine), mlA (1-methyladenosine); m2A (2-methyladenosine); Am (2-1-O-methyladenosine); ms2m6A (2-methylthio-N6-methyladenosine); i6A (N6-isopentenyladenosine); ms2i6A (2-methylthio-N6isopentenyladenosine); io6A (N6-(cis-hydroxyisopentenyl)adenosine); ms2io6A (2-methylthio-N6-(cis-hydroxyisopentenyl) adenosine); g6A (N6-glycinylcarbamoyladenosine); t6A (N6-threonyl carbamoyladenosine); ms2t6A (2-methylthio-N6-threonyl carbamoyladenosine); m6t6A (N6-methyl-N6-threonylcarbamoyladenosine); hn6A(N6-hydroxynorvalylcarbamoyl adenosine); ms2hn6A (2-methylthio-N6-hydroxynorvalyl carbamoyladenosine); Ar(p) (2'-0-ribosyladenosine (phosphate)); I (inosine); mil (1-methylinosine); m'lm (1 ,2'-0-dimethylinosine); m3C (3-methylcytidine); Cm (2T-0-methylcytidine); s2C (2-thiocytidine); ac4C (N4-acetylcytidine); £SC (5-fonnylcytidine); m5Cm (5,2-O-dimethylcytidine); ac4Cm (N4acetyl2TOmethylcytidine); k2C (lysidine); mlG (1-methylguanosine); m2G (N2-methylguanosine); m7G (7-methylguanosine); Gm (2'-0-methylguanosine); m22G (N2,N2-dimethylguanosine); m2Gm (N2,2'-0-dimethylguanosine); m22Gm (N2,N2,2'-0-trimethylguanosine); Gr(p) (2'-0-ribosylguanosine (phosphate)); yW (wybutosine); o2yW (peroxywybutosine); OHyW (hydroxywybutosine); OHyW* (undermodified hydroxywybutosine); imG (wyosine); mimG (methylguanosine); Q (queuosine); oQ (epoxyqueuosine); galQ (galtactosyl-queuosine); manQ (mannosyl-queuosine); preQo (7-cyano-7-deazaguanosine); preQi (7-aminomethyl-7-deazaguanosine); G* (archaeosine); D (dihydrouridine); m5Um (5,2'-0-dimethyluridine); s4U (4-thiouridine); m5s2U (5-methyl-2-thiouridine); s2Um (2-thio-2'-0-methyluridine); acp3U (3-(3-amino-3-carboxypropyl)uridine); ho5U (5-hydroxyuridine); mo5U (5-methoxyuridine); cmo5U (uridine 5-oxyacetic acid); mcmo5U (uridine 5-oxyacetic acid methyl ester); chm5U (5-(carboxyhydroxymethyl)uridine)); mchm5U (5-(carboxyhydroxymethyl)uridine methyl ester); mcm5U (5-methoxycarbonyl methyluridine); mcm5Um (S-methoxycarbonylmethyl-2-O-methyluridine); mcm5s2U (5-methoxycarbonylmethyl-2-thiouridine); nm5s2U (5-aminomethyl-2-thiouridine); mnm5U (5-methylaminomethyluridine); mnm5s2U (5-methylaminomethyl-2-thiouridine); mnm5se2U (5-methylaminomethyl-2-selenouridine); ncm5U (5-carbamoylmethyl uridine); ncm5Um (5-carbamoylmethyl-2'-O-methyluridine); cmnm5U (5-carboxymethylaminomethyluridine); cnmm5Um (5-carboxymethy 1 aminomethyl-2-L- Omethyl uridine); cmnm5s2U (5-carboxymethylaminomethyl-2-thiouridine); m62A (N6,N6-dimethyladenosine); Tm (2'-0-methylinosine); m4C (N4-methylcytidine); m4Cm (N4,2-0-dimethylcytidine); hm5C (5-hydroxymethylcytidine); m3U (3-methyluridine); cm5U (5-carboxymethyluridine); m6Am (N6,T-0-dimethyladenosine); rn62Am (N6,N6,0-2-trimethyladenosine); m2'7G (N2,7-dimethylguanosine); m2'2'7G (N2,N2,7-trimethylguanosine); m3Um (3,2T-0-dimethyluridine); m5D (5-methyldihydrouridine); £SCm (5-formyl-2'-0-methylcytidine); mlGm (1 ,2'-0-dimethylguanosine); m'Am (1 ,2-O-dimethyl adenosine) irinomethyluridine); tm5s2U (S-taurinomethyl-2-thiouridine)); iniG-14 (4-demethyl guanosine); imG2 (isoguanosine); ac6A (N6-acetyladenosine), hypoxanthine, inosine, 8-oxo-adenine, 7-substituted derivatives thereof, dihydrouracil, pseudouracil, 2-thiouracil, 4-thiouracil, 5-aminouracil, 5-(Ci-Ce)-alkyluracil, 5-methyluracil, 5-(C2-C6)-alkenyluracil, 5-(C2-Ce)-alkynyluracil, 5-(hydroxymethyl)uracil, 5-chlorouracil, 5-fluorouracil, 5-bromouracil, 5-hydroxycytosine, 5-(Ci-C6)-alkylcytosine, 5-methylcytosine, 5-(C2-C6)-alkenylcytosine, 5-(C2-C6)-alkynylcytosine, 5-chlorocytosine, 5-fluorocytosine, 5-bromocytosine, N2-dimethylguanine, 7-deazaguanine, 8-azaguanine, 7-deaza-7-substituted guanine, 7-deaza-7-(C2-C6)alkynylguanine, 7-deaza-8-substituted guanine, 8-hydroxyguanine, 6-thioguanine, 8-oxoguanine, 2-aminopurine, 2-amino-6-chloropurine, 2,4-diaminopurine, 2,6-diaminopurine, 8-azapurine, substituted 7-deazapurine, 7-deaza-7-substituted purine, 7-deaza-8-substituted purine, hydrogen (abasic residue), m5C, m5U, m6A, s2U, W, or 2'-0-methyl-U. Many of these modified nucleobases and their corresponding ribonucleosides are available from commercial suppliers.

Terms

[0087] As used herein, a "high-risk" HPV type (hrHPV type) is one where cervical infection with that type is known to be associated with high-grade cervical intraepithelial neoplasia or cancer. As used herein, hrHPV types are 16, 18, 31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, and 82, which have been identified in the scientific literature as high-risk. "Low-risk" HPV types are those where cervical infection with that type has not been associated with high-grade cervical intraepithelial neoplasia or cancer.

[0088] As used herein, the term "antigen" refers to a molecule containing one or more epitopes (e.g., linear, conformational or both) capable of stimulating a mammalian host's immune system to make a humoral and/or cellular antigen-specific immunological response (i.e. an immune response which specifically recognizes a naturally occurring polypeptide, e.g., a viral or bacterial protein). An "epitope" is that portion of an antigen that determines its immunological specificity. T- and B-cell epitopes can be identified empirically (e.g. using PEPSCAN or similar methods).

[0089] As used herein, an "HPV antigenic peptide" refers to a fragment of a naturally-occurring HPV protein of at least 10, 15, 20, 30, 40, 50, 60, 100, 200, 300 or more amino acids, or a peptide having an amino acid sequence of at least 85%, 90%, 95%, 97%, 98%, 99%, or 99.5% sequence identity to a naturally-occurring HPV protein (or to a fragment of a naturally-occurring HPV protein of at least about 10, 15, 20, 30, 40, 50, 60 or more amino acids). Thus an HPV antigenic peptide may be a fragment of a naturally occurring HPV protein, of at least 10 amino acids, and may comprise one or more amino acid substitutions, deletions or additions. "HPV antigenic peptides" are antigens as defined herein. Examples of full-length HPV16 E1, E2, E6 and E7 proteins are provided herein as SEQ ID NOs: 14, 15, 16 and 17, respectively. The amino acid sequences of Early proteins for additional HPV types are publicly available, e.g., via the GenBank™ genetic sequence database, National Center for Biotechnology Information (available at www(dot)ncbi.nlm.nih.gov/genbank/ (see also Nucleic Acids Research, Jan 2013: 41(D1):D36-42)).

[0090] As used herein, the term "fragment" as applied to a protein or peptide refers to a subsequence of a larger protein or peptide. A "fragment" of a protein or peptide is at least about 10 amino acids in length (amino acids naturally occurring as consecutive amino acids; e.g., as for a single linear epitope); for example at least about 15, 20, 30, 40, 50, 60, 100, 200, 300 or more amino acids in length (and any integer value in between). Antigenic HPV polypeptides may comprise two or more fragments of an HPV protein linked together.

[0091] As used herein, a peptide "fusion construct" or a "fusion protein" refers to a polypeptide comprising amino acid sequences (full-length sequence or fragments) from at least two distinct proteins. Thus a fusion construct may contain two, three, or more sequences of the same protein from at least two HPV types (e.g., fragments of E6 protein from HPV 31 and HPV33), or sequences of different proteins from a single HPV type (e.g., fragments or full-length sequences of E1 and E7 proteins from HPV16). The sequences are typically covalently linked via a peptide bond, either directly or via an amino acid linker. The term may also refer to a protein comprising at least two sequences from distinct polypeptides that are linked non-covalently. The polypeptides forming the fusion protein are typically linked C-terminus to N-terminus, although they can also be linked C-terminus to C-terminus, N-terminus to N-terminus, or N-terminus to C-terminus. The polypeptides of the fusion protein can be in any order. The sequences in a peptide fusion construct may also contain amino acid substitutions, deletions or additions.

[0092] A peptide linker sequence may be employed to separate the polypeptide components of a fusion protein. Separation is by a distance sufficient to ensure that each polypeptide folds into functional secondary and tertiary structures. Such a peptide linker sequence is incorporated into the fusion protein using standard techniques known in the art. Suitable peptide linker sequences may be chosen based on the following factors: (1) their ability to adopt a flexible extended conformation; (2) their inability to adopt a secondary structure that could interact with functional epitopes on the first and second polypeptides; and (3) the lack of hydrophobic or charged residues that might react with the polypeptide functional epitopes. Preferred peptide linker sequences contain Gly, Asn and Ser residues. Other near neutral amino acids, such as Thr and Ala may also be used in the linker sequence. Amino acid sequences which may be usefully employed as linkers include those disclosed in Maratea et al., Gene 40:39-46 (1985); Murphy et al., Proc. Natl. Acad. Sci. USA 83:8258-8262 (1986); U.S. Pat. No. 4,935,233 and U.S. Pat. No. 4,751,180. The linker sequence may generally be from 1 to about 50 amino acids in length for example 1, 5, 10, 15, 20, 25, 30, 35 or 40 amino acids in length. Linker sequences are not required when the first and second polypeptides have non-essential N-terminal amino acid regions that can be used to separate the functional domains and prevent steric interference.

[0093] An HPV E protein (e.g., E1, E2, E6, or E7) may vary in amino acid sequence between different HPV strains. For this reason the term 'equivalent amino acids,' or 'corresponding amino acids' refers to amino acids in a first sequence which correspond to those of an identified reference strain. A region of equivalent amino acids may be determined by aligning the amino acid sequences of the proteins from the different strains, using an alignment program such as BLAST® (available at blast.ncbi.nlm.nih.gov, last accessed 12 September 2016).

[0094] As used herein, the terms "treat" and "treatment," as well as words stemming therefrom, are not meant to imply a "cure" of the condition being treated in all individuals, or 100% effective treatment in any given population. Rather, there are varying degrees of treatment which one of ordinary skill in the art recognizes as having beneficial therapeutic effect(s). In this respect, the inventive methods can provide any level of treatment of HPV-associated disease in a subject in need of such treatment, and may comprise elimination of an HPV infection, reduction in the severity or duration of one or more conditions or symptoms of HPV-associated disease, a delay in the progression of low-grade clinical disease (e.g., CIN1 or LSIL), or a reduction in the percentage of abnormal (dysplatic) cervical epithelial cells. The methods of the invention may simultaneously treat persistent cervical infection and low-grade HPV-related lesions, as infected cells may exist outside of identifiable lesions.

[0095] As used herein, "therapeutic immunization" or "therapeutic vaccination" refers to administration of the immunogenic compositions of the invention to a subject, preferably a human subject, who is known to be infected with HPV at the time of administration, to treat the HPV infection or HPV-related disease.

[0096] The terms polypeptide, peptide and protein are used interchangeably herein.

[0097] In one aspect, polynucleotides or polypeptides described herein are suitably isolated. An "isolated" polynucleotide or polypeptide is one that is removed from its original environment. An isolated antigenic HPV polypeptide is one that is removed from the HPV environment. An isolated antigenic HPV polypeptide 'from' a particular HPV protein is a polypeptide whose sequence aligns with a wild-type HPV sequence, optionally containing one, two, or more amino acid substitutions, deletions or insertions, such that the sequence of the isolated antigenic HPV polypeptide is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to the corresponding amino acids in the wild-type sequence. A polypeptide 'from' an HPV protein (or HPV type) does not mean the polypeptide has been removed from an intact protein (or HPV type), the polypeptide may be provided synthetically or recombinantly.

[0098] A naturally-occurring polynucleotide is isolated if it is separated from some or all of the coexisting materials in the natural system. A polynucleotide is considered to be isolated if, for example, it is cloned into a vector that is not a part of its natural environment or if it is comprised within cDNA.

[0099] In one aspect, the polynucleotides described herein are suitably recombinant. Recombinant means that the polynucleotide is the product of at least one of cloning, restriction or ligation steps, or other procedures that result in a polynucleotide that is distinct from a polynucleotide found in nature. A recombinant vector is a vector comprising a recombinant polynucleotide. A 'recombinant virus' includes progeny of the original recombinant virus. A 'RNA vector' includes replicates of the original RNA vector. A 'recombinant polynucleotide' includes replicates of the original recombinant polynucleotide.

[0100] As used herein, a polynucleotide introduced by genetic engineering techniques into a plasmid or vector derived from a different species (or different genus, subfamily or family) is a heterologous polynucleotide. A promoter removed from its native coding sequence and operatively linked to a coding sequence with which it is not naturally found linked is a heterologous promoter. A specific recombination site that has been cloned into a genome of a virus or viral vector, wherein the genome of the virus does not naturally contain it, is a heterologous recombination site. A heterologous nucleic acid sequence also includes a sequence naturally found in an adenoviral genome, but located at a non-native position within the adenoviral vector.

[0101] Typically, "heterologous" means derived from a genotypically distinct entity from that of the rest of the entity to which it is being compared. With regard to adenoviral vectors, a heterologous nucleic acid sequence refers to any nucleic acid sequence that is not isolated from, derived from, or based upon a naturally occurring nucleic acid sequence of the adenoviral vector. "Naturally occurring" means a sequence found in nature and not synthetically prepared or modified. A sequence is "derived" from a source when it is isolated from a source but modified (e.g., by deletion, substitution (mutation), insertion, or other modification), suitably so as not to disrupt the normal function of the source gene.

[0102] A "functional derivative" of a polypeptide suitably refers to a modified version of a polypeptide, e.g. wherein one or more amino acids of the polypeptide may be deleted, inserted, modified and/or substituted.

[0103] "Variant" as used herein, is a peptide sequence that differs in sequence from a reference peptide sequence, but retains essential properties of the reference molecule. Changes in the sequence of peptide variants are limited or conservative, so that the sequences of the reference peptide and the variant are closely similar overall and, in many regions, identical. A variant and reference peptide can differ in amino acid sequence by one or more substitutions, additions, deletions in any combination. A variant of a peptide can be naturally occurring such as an allelic variant, or can be a variant that is not known to occur naturally. Non-naturally occurring variants of nucleic acids and peptides may be made by mutagenesis techniques or by direct synthesis.

[0104] A "vector" is a replicon, such as plasmids, phagemids, cosmids, baculoviruses, bacmids, bacterial artificial chromosomes (BACs), yeast artificial chromosomes (YACs), as well as other bacterial, yeast and viral vectors, to which another nucleic acid segment may be operably inserted so as to bring about the replication or expression of the inserted segment. "Expression vector" refers to a vector comprising expression control sequences operatively linked to a nucleotide sequence to be expressed. An expression vector comprises sufficient cis-acting elements for expression; other elements for expression can be supplied by the host cell or in an in vitro expression system. Expression vectors include cosmids, plasmids, and viruses (e.g., lentiviruses, retroviruses, adenoviruses, and adeno-associated viruses) that incorporate or encode the RNA construct(s).

[0105] "Encoding" refers to the inherent property of specific sequences of nucleotides in a polynucleotide, to act as a template for synthesis of other polymers and macromolecules in biological processes, e.g., synthesis of peptides or proteins. Both the coding strand of a double-stranded nucleotide molecule (the sequence of which is usually provided in sequence listings), and the non-coding strand (used as the template for transcription of a gene or cDNA), can be referred to as encoding the peptide or protein. Unless otherwise specified, as used herein a "nucleotide sequence encoding an amino acid sequence" includes all nucleotide sequences that are degenerate versions of each other and that encode the same amino acid sequence.

[0106] The term "expression" or "expressing" as used herein is defined as the transcription and/or translation of a particular nucleotide sequence driven by its operably linked promoter.

[0107] Unless otherwise explained, all technical and scientific terms used herein have the same meaning as commonly understood by one of ordinary skill in the art to which this disclosure belongs. Definitions of common terms in molecular biology can be found in Benjamin Lewin, Genes V, published by Oxford University Press, 1994 (ISBN 0-19-854287-9); Kendrew et al. (eds.), The Encyclopedia of Molecular Biology, published by Blackwell Science Ltd., 1994 (ISBN 0-632-02182-9); and Robert A. Meyers (ed.), Molecular Biology and Biotechnology: a Comprehensive Desk Reference, published by VCH Publishers, Inc., 1995 (ISBN 1-56081-569-8).

[0108] The singular terms "a," "an," and "the" include plural referents unless context clearly indicates otherwise. Similarly, the word "or" is intended to include "and" unless the context clearly indicates otherwise. The term "plurality" refers to two or more. It is further to be understood that all base sizes or amino acid sizes, and all molecular weight or molecular mass values, given for nucleic acids or polypeptides are approximate, and are provided for description. Additionally, numerical limitations given with respect to concentrations or levels of a substance, such as an antigen, are intended to be approximate. Thus, where a concentration is indicated to be at least (for example) 200 pg, it is intended that the concentration be understood to be at least approximately (or "about" or "∼") 200 pg.

[0109] Although methods and materials similar or equivalent to those described herein can be used in the practice or testing of this disclosure, suitable methods and materials are described below. The term "comprises" means "includes." Thus, unless the context requires otherwise, the word "comprises," and variations such as "comprise" and "comprising" will be understood to imply the inclusion of a stated compound or composition (e.g., nucleic acid, polypeptide, antigen) or step, or group of compounds or steps, but not to the exclusion of any other compounds, composition, steps, or groups thereof. The abbreviation, "e.g." is derived from the Latin exempli gratia, and is used herein to indicate a non-limiting example and is synonymous with the term "for example."

[0110] Amino acid sequences provided herein are designated by either single-letter or three-letter nomenclature, as is known in the art (see, e.g., Eur. J. Biochem. 138:9-37(1984)).

[0111] "Fusion protein" and "chimeric protein" are used interchangeably herein, and refer to a recombinant polypeptide sequence that comprises contiguous sequences from two separate proteins, i.e., two proteins encoded by different genes.

[0112] To facilitate review of the various embodiments of this disclosure, the preceeding explanations of terms are provided. Additional terms and explanations are provided in the context of this disclosure.

Sequence Comparison

[0113] For the purposes of comparing two closely-related polynucleotide or polypeptide sequences, the "sequence identity" or "% identity" between a first sequence and a second sequence may be calculated using an alignment program, such as BLAST® (available at blast.ncbi.nlm.nih.gov, last accessed 12 September 2016) using standard settings. The percentage identity is the number of identical residues divided by the length of the alignment, multiplied by 100. An alternative definition of identity is the number of identical residues divided by the number of aligned residues, multiplied by 100. Alternative methods include using a gapped method in which gaps in the alignment, for example deletions in one sequence relative to the other sequence, are considered.

[0114] Sequences that preserve the functionality of the polynucleotide or a polypeptide encoded thereby are likely to be more closely identical. Polypeptide or polynucleotide sequences are said to be identical to other polypeptide or polynucleotide sequences, if they share 100% sequence identity over their entire length.

[0115] A "difference" between two sequences refers to an insertion, deletion or substitution, e.g., of a single amino acid residue in a position of one sequence, compared to the other sequence.

[0116] For the purposes of comparing a first, reference polypeptide sequence to a second, comparison polypeptide sequence, the number of additions, substitutions and/or deletions made to the first sequence to produce the second sequence may be ascertained. An addition is the addition of one amino acid residue into the sequence of the first polypeptide (including addition at either terminus of the first polypeptide). A substitution is the substitution of one amino acid residue in the sequence of the first polypeptide with one different amino acid residue. A deletion is the deletion of one amino acid residue from the sequence of the first polypeptide (including deletion at either terminus of the first polypeptide).

[0117] Suitably substitutions in the sequences of the present invention may be conservative substitutions. A conservative substitution comprises the substitution of an amino acid with another amino acid having a physic-chemical property similar to the amino acid that is substituted (see, for example, Stryer et al, Biochemistry, 5th Edition 2002, pages 44-49). Preferably, the conservative substitution is a substitution selected from the group consisting of: (i) a substitution of a basic amino acid with another, different basic amino acid; (ii) a substitution of an acidic amino acid with another, different acidic amino acid; (iii) a substitution of an aromatic amino acid with another, different aromatic amino acid; (iv) a substitution of a non-polar, aliphatic amino acid with another, different non-polar, aliphatic amino acid; and (v) a substitution of a polar, uncharged amino acid with another, different polar, uncharged amino acid. A basic amino acid is preferably selected from the group consisting of arginine, histidine, and lysine. An acidic amino acid is preferably aspartate or glutamate. An aromatic amino acid is preferably selected from the group consisting of phenylalanine, tyrosine and tryptophane. A non-polar, aliphatic amino acid is preferably selected from the group consisting of glycine, alanine, valine, leucine, methionine and isoleucine. A polar, uncharged amino acid is preferably selected from the group consisting of serine, threonine, cysteine, proline, asparagine and glutamine. In contrast to a conservative amino acid substitution, a non-conservative amino acid substitution is the exchange of one amino acid with any amino acid that does not fall under the above-outlined conservative substitutions (i) through (v).

Transgenes

[0118] The present inventors disclose compositions comprising RNA construct(s) which encode antigenic HPV polypeptides as described herein. Such compositions may be a nucleic acid-based vaccine. The part of the RNA construct encoding the antigenic HPV polypeptides is also referred to as transgene and further defined herein.

[0119] The "transgene" is a nucleic acid sequence, heterologous to the vector sequences flanking the transgene, which encodes protein(s) or peptide(s) of interest (i.e. "transgene product"), including, e.g. a protein having a therapeutic effect when delivered to a subject in need of treatment. The transgene nucleic acid coding sequence is operatively linked to regulatory components in a manner which permits transgenetranslation, and/or expression in a host cell. HPV transgenes as disclosed herein may be used for induction of an immune response in order to treat HPV-related disease (a therapeutic vaccine), such as low-grade HPV lesions, in particular infections and lesions of human anogenital tissue such as cervical epithelia. As used herein, induction of an immune response refers to the ability of a protein to induce a T cell and/or a humoral immune response to the protein.

[0120] The transgene sequences of the present invention are designed to encode multiple antigenic HPV polypeptide sequences (or to encode one or more polypeptides comprising multiple linked antigenic HPV peptide sequences). The antigenic HPV peptide(s) comprise fragment(s) of HPV Early proteins from fewer than all of the hrHPV types (as defined herein), where the antigenic HPV peptides are selected or designed to include sequences that are conserved across multiple high-risk HPV types, and to include CD8 and/or CD4 T-cell epitopes. Such sequences increase the ability of the transgene to induce cross-reactive or immune response to multiple hrHPV types when administered to a mammalian subject such as a human, including inducing immune responses to 'additional' hrHPV types (i.e., those hrHPV types that are not represented in the transgene).

[0121] Cross-reactivity to additional hrHPV types is obtained by: analyzing the sequence of an HPV early protein from a first hrHPV type and selecting regions (e.g., fragments) of that protein with high levels of identity and/or similarity across multiple hrHPV types (see eg. Table 1 herein). This process may be repeated for additional early proteins from the first hrHPV type, and repeated for HPV early proteins from a second, third, fourth, fifth, sixth, seventh and/or eighth hrHPV type ('selected' HPV types). The vaccine vector constructs of the present invention are designed to provide a group of antigenic polypeptides that include polypeptides having at least about 60% sequence similarity, at least about 70% sequence identity, at least about 75% sequence identity, at least about 80% or higher sequence identity to corresponding early proteins from additional (non-selected) hrHPV types.

[0122] The amino acid sequences of full-length HPV16 E1, E2, E6 and E7 proteins are provided herein as SEQ ID NOs: 14, 15, 16 and 17, respectively. The amino acid sequences of Early proteins for additional HPV types are publicly available, e.g., via the GenBank™ genetic sequence database, National Center for Biotechnology Information (available at www(dot)ncbi.nlm.nih.gov/genbank/ (see also Nucleic Acids Research, Jan 2013: 41(D1):D36-42)).

[0123] Stated another way, the method of the present invention comprises administration of one or more RNA construct(s) (eg. co-administration of two or more RNA constructs) expressing antigenic polypeptides from two or more HPV Early proteins, from fewer than all fifteen hrHPV types (i.e., from a selected subset of the fifteen hrHPV types identified herein), such that the expressed polypeptides include polypeptides having at least about 70% identity with the corresponding region of the Early proteins of at least one additional (i.e., non-selected) hrHPV type.. The RNA construct(s) used in the present invention may further express antigenic polypeptides from a third and optionally a fourth HPV Early protein of the selected hrHPV types, to provide polypeptides having at least about 70% identity with the corresponding region of the third and optionally fourth Early protein of at least one additional (non-selected) hrHPV type. In apreferred embodiment, the one or more RNA construct(s) express antigenic polypeptides from HPV E1, E2 and E6 from fewer than all fifteen hrHPV types such that the expressed polypeptides include polypeptides having at least about 70% identity with the corresponding region of HPV E1, E2 and E6 of at least one additional (i.e., non-selected) hrHPV type. More preferably, the RNA construct(s) express antigenic polypeptides from HPV E7 from fewer than all fifteen hrHPV types such that the expressed polypeptides include polypeptides having at least about 70% identity with the corresponding region of HPV E7 of at least one additional (i.e., non-selected) hrHPV type.

[0124] In one embodiment, the method of the present invention comprises administration of one or more RNA construct(s) (eg. co-administration of two, three or more RNA constructs) that express (a) antigenic polypeptides from each of E1, E2 and E6 of HPV16 and HPV18, and (b) additional antigenic polypeptides from E1, E2 and/or E6 from an additional one, two, three, four, five or six hrHPV types; such that for each of the fifteen hrHPV types identified herein, at least one antigenic polypeptide is administered that has at least 70% sequence identity to at least one of the hrHPV E1, E2 or E6 proteins.

[0125] In one embodiment, the method of the present invention comprises administration of one or more RNA construct(s) (eg. co-administration of two, three or more RNA constructs) that express (a) antigenic polypeptides from each of E1, E2, E6 and E7 of HPV16 and HPV18, and (b) additional antigenic polypeptides from E1, E2, E6 and/or E7 from an additional one, two, three, four, five or six hrHPV types; such that for each of the fifteen hrHPV types identified herein, at least one antigenic polypeptide is administered that has at least 70% sequence identity to at least one of the hrHPV E1, E2, E6 or E7 proteins.

[0126] In a further embodiment, the method of the present invention comprises administration of one or more RNA construct(s) (eg. co-administration of two, three or more RNA constructs) that express (a) antigenic polypeptides from each of E1, E2 and E6 of HPV16 and HPV18, and (b) additional antigenic polypeptides from E1, E2 and/or E6 from HPV31, 33, 45, 52 and 58; such that antigenic polypeptides having at least about 70% similarity to at least two of the E1, E2 and E6 early proteins from each of HPV16, 18, 31, 33, 45, 52 and 58 are administered. In one embodiment, no E1 antigenic polypeptides from HPV31, 33, 45, 52 and 58 are administered.

[0127] In a further embodiment, the method of the present invention comprises administration of one or more RNA construct(s) (eg. co-administration of two, three or more RNA constructs) that express (a) antigenic polypeptides from each of E1, E2, E6 and E7 of HPV16 and HPV18, and (b) additional antigenic polypeptides from E1, E2, E6 and/or E7 from HPV31, 33, 45, 52 and 58; such that antigenic polypeptides having at least about 70% similarity to at least two of the E1, E2, E6 and E7 early proteins from each of HPV16, 18, 31, 33, 45, 52 and 58 are administered. In one embodiment, no E7 antigenic polypeptides from HPV31, 33, 45, 52 and 58 are administered. In one embodiment, no E1 antigenic polypeptides from HPV31, 33, 45, 52 and 58 and no E7 antigenic polypeptides from HPV31, 33, 45, 52 and 58 are administered.

[0128] An antigenic HPV polypeptide from a specific Early protein, from a specific HPV type, as utilized in the present invention, may include two non-contiguous amino acid sequences from that Early protein, linked either directly or via a short (e.g., ten or fewer amino acids) peptide linker. Additionally, an antigenic HPV polypeptide may contain one, two, three, or more amino acid substitutions (compared to the wild-type sequence), e.g., to eliminate or alter the activity of the expressed polypeptides. In one embodiment, an antigenic HPV polypeptide contains a single amino acid substitution. In another embodiment, an antigenic HPV polypeptide contains two amino acid substitutions.

[0129] Antigenic HPV polypeptides utilized in the present methods are preferably selected to contain at least one CD8 or CD4 T-cell epitope. Epitopes may be those identified theoretically or empirically.

[0130] In one aspect of the present invention, the transgene of the RNA construct(s) encodes at least one antigenic peptide from the E2 and E6 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E2 and E6, and at least one antigenic peptide from each of HPV18 E2 and E6. In a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from E1 and/or E7 of HPV16 and/or HPV18. In a further embodiment, the transgene additionally encodes at least one antigenic peptide from the E2 and E6 proteins of an additional hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0131] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E2 and E6 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E2 and E6 proteins, and at least one antigenic peptide from each of HPV18 E2 and E6 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E2 protein and/or at least one antigenic HPV peptide from the E6 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0132] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E1 and E7 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E1 and E7 proteins, and at least one antigenic peptide from each of HPV18 E1 and E7 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E1 protein, and/or at least one antigenic HPV peptide from the E7 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0133] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E1 and E2 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E1 and E2 proteins, and at least one antigenic peptide from each of HPV18 E1 and E2 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E1 protein, and/or at least one antigenic HPV peptide from the E2 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0134] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E1 and E6 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E1 and E6 proteins, and at least one antigenic peptide from each of HPV18 E1 and E6 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E1 protein, and/or at least one antigenic HPV peptide from the E6 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0135] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E2 and E7 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E2 and E7 proteins, and at least one antigenic peptide from each of HPV18 E2 and E7 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E2 protein, and/or at least one antigenic HPV peptide from the E7 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0136] In another aspect of the present invention, the transgene of the vector(s) encodes at least one antigenic peptide from the E6 and E7 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from each of HPV16 E6 and E7 proteins, and at least one antigenic peptide from each of HPV18 E6 and E7 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E6 protein, and/or at least one antigenic HPV peptide from the E7 protein, of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0137] In another aspect of the present invention, the transgene of the vectors encodes at least one antigenic peptide from each of E1, E2 and E6 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from HPV16 E1, E2 and E6 proteins, and at least one antigenic peptide from each of HPV18 E1, E2 and E6 proteins. In a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E1, E2 or E6 proteins of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0138] In another aspect of the present invention, the transgene of the vectors encodes at least one antigenic peptide from any three of the E1, E2, E6 and E7 proteins of at least two high-risk HPV types. In one embodiment, the transgene encodes at least one antigenic peptide from any three of HPV16 E1, E2, E6 and E7 proteins, and at least one antigenic peptide from each of HPV18 E1, E2, E6 and E7 proteins; in a further embodiment, the transgene additionally encodes at least one antigenic HPV peptide from the E1, E2, E6 or E7 proteins of another hrHPV type (e.g., HPV31, 33, 35, 39, 45, 51, 52, 56, 58, 59, 68, 73, or 82).

[0139] In one embodiment the transgene of the RNA construct(s) encodes E1 antigenic peptide(s) comprising or consisting of one or more sequences selected from amino acids 14-90, aa203-622, aa211-622 (amino acid numbering corresponds to HPV16 E1, SEQ ID NO:14). The E1 fragment may comprise a Glycine to Aspartic acid substitution at amino acid residue 482 (G482D; numbering corresponds to SEQ ID NO:14). Where two E1 polypeptide sequences are used that are non-contiguous in the naturally occurring protein ('non-contiguous fragments'), they may be joined directly, joined via a peptide or non-peptide linker, or the transgene may be constructed so that the E1 fragments are expressed as separate peptides.

[0140] In one embodiment the transgene of the RNA construct(s) encodes E2 antigenic peptide(s) comprising or consisting of one or more sequences selected from amino acids 1-138, aa1-201, aa150-210, aa260-365, and aa285-365 (amino acid numbering corresponds to HPV16 E2, SEQ ID NO:15). Where the transgene encodes an E2 antigenic peptide comprising the TAD, and an E2 antigenic peptide comprising the DBD, a peptide or non-peptide linker may be placed between the TAD and DBD peptides (e.g., a peptide linker consisting of GGTGGS, SEQ ID NO:38). The E2 antigenic peptide may contain a Lysine to Alanine substitution at amino acid residue 111 (K111A, numbering corresponds to HPV16E2, SEQ ID NO:15). Where non-contiguous E2 fragments are used, they may be joined directly, joined via a peptide or non-peptide linker, or the transgene may be constructed so that the E2 fragments are expressed as separate peptides.

[0141] In one embodiment the transgene of the RNA construct(s) encodes E6 antigenic peptide(s) comprising or consisting of a sequence selected from amino acids 8-147 and aa11-150 (numbering corresponds to HPV16 E6, SEQ ID NO:16). The E6 antigenic peptide may contain a phenylalanine to arginine substitution at amino acid residue 54 (F54R) and/ or a cysteine to arginine substitution at amino acid residue 110 (C110R); numbering corresponds to to HPV16 E6, SEQ ID NO:16.

[0142] In one embodiment the transgene of the RNA construct(s) encodes E7 antigenic peptide(s) comprising or consisting of one or more sequences selected from amino acids 49-98 and aa7-28 (amino acid numbering corresponds to HPV16 E7, SEQ ID NO:17). When the transgene contains a fragment comprising aa49-98 and a fragment comprising aa7-28 of E7, fragment aa49-98 may be placed N-terminal to aa7-28. The E7 antigenic peptide may contain a cysteine to glycine substitution at amino acid residue 24 (C24G), and/or a glutamic acid to glutamine substitution at residue 26 (E26Q); numbering corresponds to HPV16 E7, SEQ ID NO:17.

[0143] In one embodiment, the transgene comprises nucleotide sequence(s) encoding one or more HPV E1 sequences that are at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:18 and SEQ ID NO:19. In one embodiment the transgene comprises nucleotide sequence(s) encoding one or more HPV E2 sequences that are at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:20, SEQ ID NO:21, SEQ ID NO:22, SEQ ID NO:23, SEQ ID NO:24, SEQ ID NO:25 and SEQ ID NO:26. In one embodiment the transgene comprises nucleotide sequence(s) encoding one or more HPV E6 sequences that are at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:27, SEQ ID NO:28 SEQ ID NO:29, SEQ ID NO:30, SEQ ID NO:31, SEQ ID NO:32 and SEQ ID NO:33. In one embodiment the transgene comprises nucleotide sequence(s) encoding one or more HPV E7 sequences that are at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:34 and SEQ ID NO:35.

[0144] Any of the encoded HPV antigenic fragments may additionally comprise an initial methionine residue where required.

[0145] In the transgene constructs of the present invention, the nucleic acid sequences coding for HPV antigenic peptides may be separated by a peptide or non-peptide linker, or a sequence such as a ribosomal skipping sequence that interrupts translation of the transgene and results in expression of multiple peptides.

[0146] In one embodiment of the present invention, the transgene comprises or consists of a nucleotide sequence encoding an amino acid sequence that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:2, SEQ ID NO:4 and SEQ ID NO:6.

[0147] In one embodiment of the present invention, the transgene comprises or consists of a nucleotide sequence that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from SEQ ID NO:3, SEQ ID NO:5 and SEQ ID NO:7.

[0148] In one embodiment of the present invention, the transgene does not comprise a nucleotide sequence encoding an antigenic fragment of an HPV Late protein. In another embodiment, the transgene does not comprise a nucleotide sequence encoding an antigenic fragment of an Early protein from a non-high risk HPV type.

[0149] Accordingly, in one embodiment, a transgene comprising nucleic acid sequences encoding HPV E1, E2, E6 and/or E7 antigenic peptides, from multiple hrHPV types, is incorporated into an RNA viral vector, such as a self-replicating RNA (or 'SAM') vector.

[0150] The sequences of the invention may be produced by any suitable means, including recombinant production, chemical synthesis, or other synthetic means. Suitable production techniques are well known to those of skill in the art. Alternatively, peptides can also be synthesized by well known solid phase peptide synthesis methods.

Self-replicating RNA (or "SAM")

[0151] In certain embodiments, the RNA-based vaccine comprises a self-replicating RNA molecule. The self-replicating RNA molecule may be an alphavirus-derived RNA replicon.

[0152] Self-replicating RNA (or "SAM") molecules are well known in the art and can be produced by using replication elements derived from, e.g., alphaviruses, and substituting the structural viral proteins with a nucleotide sequence encoding a protein of interest. A self-replicating RNA molecule is typically a +-strand molecule which can be directly translated after delivery to a cell, and this translation provides a RNA-dependent RNA polymerase which then produces both antisense and sense transcripts from the delivered RNA. Thus the delivered RNA leads to the production of multiple daughter RNAs. These daughter RNAs, as well as collinear subgenomic transcripts, may be translated themselves to provide in situ expression of an encoded polypeptide (i.e. comprising HPV antigens), or may be transcribed to provide further transcripts with the same sense as the delivered RNA which are translated to provide in situ expression of the antigen. The overall result of this sequence of transcriptions is a huge amplification in the number of the introduced replicon RNAs and so the encoded antigen becomes a major polypeptide product of the cells.

[0153] One suitable system for achieving self-replication in this manner is to use an alphavirus-based replicon. These replicons are +-stranded RNAs which lead to translation of a replicase (or replicase-transcriptase) after delivery to a cell. The replicase is translated as a polyprotein which auto-cleaves to provide a replication complex which creates genomic-strand copies of the +-strand delivered RNA. These - -strand transcripts can themselves be transcribed to give further copies of the +-stranded parent RNA and also to give a subgenomic transcript which encodes the antigen. Translation of the subgenomic transcript thus leads to in situ expression of the antigen by the infected cell. Suitable alphavirus replicons can use a replicase from a Sindbis virus, a Semliki forest virus, an eastern equine encephalitis virus, a Venezuelan equine encephalitis virus, etc. Mutant or wild-type virus sequences can be used e.g. the attenuated TC83 mutant of VEEV has been used in replicons, see the following reference: WO2005/113782.

[0154] In certain embodiments, the self-replicating RNA molecule described herein encodes (i) a RNA-dependent RNA polymerase which can transcribe RNA from the self-replicating RNA molecule and (ii) a HPV antigen. The polymerase can be an alphavirus replicase e.g. comprising one or more of alphavirus proteins nsP1, nsP2, nsP3 and nsP4.

[0155] Whereas natural alphavirus genomes encode structural virion proteins in addition to the non-structural replicase polyprotein, in certain embodiments, the self-replicating RNA molecules do not encode alphavirus structural proteins. Thus, the self-replicating RNA can lead to the production of genomic RNA copies of itself in a cell, but not to the production of RNA-containing virions. The inability to produce these virions means that, unlike a wild-type alphavirus, the self-replicating RNA molecule cannot perpetuate itself in infectious form. The alphavirus structural proteins which are necessary for perpetuation in wild- type viruses are absent from self-replicating RNAs of the present disclosure and their place is taken by gene(s) encoding the immunogen of interest, such that the subgenomic transcript encodes the immunogen rather than the structural alphavirus virion proteins.

[0156] Thus a self-replicating RNA molecule useful with the invention may have two open reading frames. The first (5') open reading frame encodes a replicase; the second (3') open reading frame encodes an antigen. In some embodiments the RNA may have additional (e.g. downstream) open reading frames e.g. to encode further antigens or to encode accessory polypeptides.

[0157] In certain embodiments, the self-replicating RNA molecule disclosed herein has a 5' cap (e.g. a 7-methylguanosine). This cap can enhance in vivo translation of the RNA. In some embodiments the 5' sequence of the self-replicating RNA molecule must be selected to ensure compatibility with the encoded replicase.

[0158] A self-replicating RNA molecule may have a 3' poly-A tail. It may also include a poly-A polymerase recognition sequence (e.g. AAUAAA) near its 3' end.

[0159] Self-replicating RNA molecules can have various lengths but they are typically 5000-25000 nucleotides long. Self-replicating RNA molecules will typically be single-stranded. Single-stranded RNAs can generally initiate an adjuvant effect by binding to TLR7, TLR8, RNA helicases and/or PKR. RNA delivered in double-stranded form (dsRNA) can bind to TLR3, and this receptor can also be triggered by dsRNA which is formed either during replication of a single-stranded RNA or within the secondary structure of a single-stranded RNA.

[0160] The self-replicating RNA can conveniently be prepared by in vitro transcription (IVT). IVT can use a (cDNA) template created and propagated in plasmid form in bacteria, or created synthetically (for example by gene synthesis and/or polymerase chain-reaction (PCR) engineering methods). For instance, a DNA-dependent RNA polymerase (such as the bacteriophage T7, T3 or SP6 RNA polymerases) can be used to transcribe the self-replicating RNA from a DNA template. Appropriate capping and poly-A addition reactions can be used as required (although the replicon's poly-A is usually encoded within the DNA template). These RNA polymerases can have stringent requirements for the transcribed 5' nucleotide(s) and in some embodiments these requirements must be matched with the requirements of the encoded replicase, to ensure that the IVT-transcribed RNA can function efficiently as a substrate for its self-encoded replicase.

[0161] A self-replicating RNA can include (in addition to any 5' cap structure) one or more nucleotides having a modified nucleobase. A RNA used with the invention ideally includes only phosphodiester linkages between nucleosides, but in some embodiments it can contain phosphoramidate, phosphorothioate, and/or methylphosphonate linkages.

[0162] The self-replicating RNA molecule may encode a single heterologous polypeptide antigen or two or more heterologous antigens linked together in a way that each of the sequences retains its identity (e.g. HPV antigens) when expressed as an amino acid sequence. The heterologous polypeptides generated from the self-replicating RNA may then be produced as a fusion polypeptide or engineered in such a manner to result in separate polypeptide or peptide sequences.

[0163] The self-replicating RNA molecules described herein may be engineered to express multiple nucleotide sequences or transgenes, from two or more open reading frames, thereby allowing co-expression of proteins, such as one, two or more HPV antigens (e.g. one, two, three, four or five HPV antigen) together with cytokines or other immunomodulators, which can enhance the generation of an immune response. Such a self-replicating RNA molecule might be particularly useful, for example, in the production of various gene products (e.g., proteins) at the same time, for example, as a bivalent or multivalent vaccine.

[0164] If desired, the self-replicating RNA molecules can be screened or analyzed to confirm their therapeutic and prophylactic properties using various in vitro or in vivo testing methods that are known to those of skill in the art. For example, vaccines comprising self-replicating RNA molecule can be tested for their effect on induction of proliferation or effector function of the particular lymphocyte type of interest, e.g., B cells, T cells, T cell lines, and T cell clones. For example, spleen cells from immunized mice can be isolated and the capacity of cytotoxic T lymphocytes to lyse autologous target cells that contain a self-replicating RNA molecule that encodes HPV antigen. In addition, T helper cell differentiation can be analyzed by measuring proliferation or production of TH1 (IL-2 and IFN-γ) and /or TH2 (IL-4 and IL-5) cytokines by ELISA or directly in CD4+ T cells by cytoplasmic cytokine staining and flow cytometry.

[0165] Self-replicating RNA molecules that encode one or more HPV antigenic polypeptides can also be tested for ability to induce humoral immune responses, as evidenced, for example, by induction of B cell production of antibodies specific for an HPV antigen of interest. These assays can be conducted using, for example, peripheral B lymphocytes from immunized individuals. Such assay methods are known to those of skill in the art. Other assays that can be used to characterize the self-replicating RNA molecules can involve detecting expression of the encoded HPV antigen by the target cells. For example, FACS can be used to detect antigen expression on the cell surface or intracellularly. Another advantage of FACS selection is that one can sort for different levels of expression; sometimes-lower expression may be desired. Other suitable method for identifying cells which express a particular antigen involve panning using monoclonal antibodies on a plate or capture using magnetic beads coated with monoclonal antibodies.

[0166] In some embodiments, the self-replicating RNA molecules comprise a sequence which is at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% identical to a sequence selected from the group consisting of SEQ ID NO:9, SEQ ID NO:11 or SEQ ID NO:13. In some embodiments, the self-replicating RNA molecule comprises a fragment of a full-length sequence selected from the group consisting of SEQ ID NO:9, SEQ ID NO:11 or SEQ ID NO:13 wherein the fragment comprises a contiguous stretch of the nucleic acid sequence of the full-length sequence up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, or 30 nucleic acids shorter than full-length sequence.

[0167] In some embodiments, a DNA sequence encoding a self-replicating RNA molecule is provided, such as a DNA sequence encoding a self-replicating RNA molecule comprises a sequence which is at least 70%, at least 75%, at least 80%, at least 85%, at least 90%, at least 95%, at least 96%, at least 97%, at least 98%, or at least 99% identical to a sequence selected from the group consisting of SEQ ID NO:8, SEQ ID NO:10 or SEQ ID NO:12. In some embodiments, the DNA sequence encoding a self-replicating RNA molecule comprises a fragment of a full-length sequence selected from the group consisting of SEQ ID NO:8, SEQ ID NO:10 or SEQ ID NO:12 wherein the fragment comprises a contiguous stretch of the nucleic acid sequence of the full-length sequence up to 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 15, 20, 25, or 30 nucleic acids shorter than full-length sequence.

[0168] The nucleic acid-based composition comprising the RNA-based constructs may comprise a viral or a non-viral delivery system. The delivery system (also referred to herein as a delivery vehicle) may have adjuvant effects which enhance the immunogenicity of the encoded HPV antigen. For example, the nucleic acid molecule may be encapsulated in liposomes, non-toxic biodegradable polymeric microparticles or viral replicon particles (VRPs), or complexed with particles of a cationic oil-in-water emulsion. In some embodiments, the nucleic acid-based vaccine comprises a cationic nano-emulsion (CNE) delivery system or a lipid nanoparticle (LNP) delivery system. In some embodiments, the nucleic acid-based vaccine comprises a non-viral delivery system, i.e., the nucleic acid-based vaccine is substantially free of viral capsid. Alternatively, the nucleic acid-based vaccine may comprise viral replicon particles. In other embodiments, the nucleic acid-based vaccine may comprise a naked nucleic acid, such as naked RNA (e.g. mRNA), but delivery via CNEs or LNPs is preferred.

[0169] In certain embodiments, the nucleic acid-based vaccine comprises a cationic nano-emulsion (CNE) delivery system. CNE delivery systems and methods for their preparation are described in the following reference: WO2012/006380. In a CNE delivery system, the nucleic acid molecule (e.g. RNA) which encodes the antigen is complexed with a particle of a cationic oil-in-water emulsion. Cationic oil-in-water emulsions can be used to deliver negatively charged molecules, such as an RNA molecule to cells. The emulsion particles comprise an oil core and a cationic lipid. The cationic lipid can interact with the negatively charged molecule thereby anchoring the molecule to the emulsion particles. Further details of useful CNEs can be found in the following references: WO2012/006380; WO2013/006834; and WO2013/006837 (the contents of each of which are incorporated herein in their entirety).

[0170] Thus, in a nucleic acid-based vaccine of the invention, an RNA molecule encoding a HPV antigenic polypeptides may be complexed with a particle of a cationic oil-in-water emulsion. The particles typically comprise an oil core (e.g. a plant oil or squalene) that is in liquid phase at 25°C, a cationic lipid (e.g. phospholipid) and, optionally, a surfactant (e.g. sorbitan trioleate, polysorbate 80); polyethylene glycol can also be included. In some embodiments, the CNE comprises squalene and a cationic lipid, such as 1,2-dioleoyloxy-3-(trimethylammonio) propane (DOTAP). In some preferred embodiments, the delivery system is a non viral delivery system, such as CNE, and the nucleic acid-based vaccine comprises a self-replicating RNA (mRNA). This may be particularly effective in eliciting humoral and cellular immune responses. Advantages also include the absence of a limiting anti- vector immune response and a lack of risk of genomic integration.

[0171] LNP delivery systems and non-toxic biodegradable polymeric microparticles, and methods for their preparation are described in the following references: WO2012/006376 (LNP and microparticle delivery systems); Geall et al. (2012) PNAS USA. Sep 4; 109(36): 14604-9 (LNP delivery system); and WO2012/006359 (microparticle delivery systems). LNPs are non- virion liposome particles in which a nucleic acid molecule (e.g. RNA) can be encapsulated. The particles can include some external RNA (e.g. on the surface of the particles), but at least half of the RNA (and ideally all of it) is encapsulated. Liposomal particles can, for example, be formed of a mixture of zwitterionic, cationic and anionic lipids which can be saturated or unsaturated, for example; DSPC (zwitterionic, saturated), DlinDMA (cationic, unsaturated), and/or DMG (anionic, saturated). Preferred LNPs for use with the invention include an amphiphilic lipid which can form liposomes, optionally in combination with at least one cationic lipid (such as DOTAP, DSDMA, DODMA, DLinDMA, DLenDMA, etc.). A mixture of DSPC, DlinDMA, PEG-DMG and cholesterol is particularly effective. Other useful LNPs are described in the following references: WO2012/006376; WO2012/030901; WO2012/031046; WO2012/031043; WO2012/006378; WO2011/076807; WO2013/033563; WO2013/006825; WO2014/136086; WO2015/095340; WO2015/095346; WO2016/037053. In some embodiments, the LNPs are RV01 liposomes, see the following references: WO2012/006376 and Geall et al. (2012) PNAS USA. Sep 4; 109(36): 14604-9.

Pharmaceutical Compositions; Immunogenic Compositions

[0172] The disclosure provides compositions comprising one or more RNA constructs encoding antigenic HPV polypeptides as described herein. The composition may be a pharmaceutical composition, e.g., an immunogenic composition or a vaccine composition. Accordingly, the composition may also comprise a pharmaceutically acceptable carrier.

[0173] A "pharmaceutically acceptable carrier" includes any carrier that does not itself induce the production of antibodies harmful to the individual receiving the composition. Suitable carriers are typically large, slowly metabolized macromolecules such as proteins, polysaccharides, polylactic acids, polyglycolic acids, polymeric amino acids, amino acid copolymers, sucrose, trehalose, lactose, and lipid aggregates (such as oil droplets or liposomes). Such carriers are well known to those of ordinary skill in the art. The compositions may also contain a pharmaceutically acceptable diluent, such as water, saline, glycerol, etc. Additionally, auxiliary substances, such as wetting or emulsifying agents, pH buffering substances, and the like, may be present. Sterile pyrogen-free, phosphate-buffered physiologic saline is a typical carrier.

[0174] Pharmaceutical compositions may include the constructs, nucleic acid sequences, and/or polypeptide sequences described elsewhere herein in plain water (e.g. "w.f.i.") or in a buffer e.g. a phosphate buffer, a Tris buffer, a borate buffer, a succinate buffer, a histidine buffer, or a citrate buffer. Buffer salts will typically be included in the 5-20mM range. Pharmaceutical compositions may have a pH between 5.0 and 9.5 e.g. between 6.0 and 8.0. Compositions may include sodium salts (e.g. sodium chloride) to give tonicity. A concentration of 10±2 mg/mL NaCl is typical, e.g. about 9 mg/mL. Compositions may include metal ion chelators. These can prolong RNA stability by removing ions which can accelerate phosphodiester hydrolysis. Thus a composition may include one or more of EDTA, EGTA, BAPTA, pentetic acid, etc.. Such chelators are typically present at between 10-500 µM e.g. 0.1 mM. A citrate salt, such as sodium citrate, can also act as a chelator, while advantageously also providing buffering activity. Pharmaceutical compositions may have an osmolality of between 200 mOsm/kg and 400 mOsm/kg, e.g. between 240-360 mOsm/kg, or between 290-310 mOsm/kg. Pharmaceutical compositions may include one or more preservatives, such as thiomersal or 2-phenoxyethanol. Mercury-free compositions are preferred, and preservative-free vaccines can be prepared. Pharmaceutical compositions may be aseptic or sterile. Pharmaceutical compositions may be non-pyrogenic e.g. containing <1 EU (endotoxin unit, a standard measure) per dose, and preferably <0.1 EU per dose. Pharmaceutical compositions may be gluten free. Pharmaceutical compositions may be prepared in unit dose form. In some embodiments a unit dose may have a volume of between 0.1 -1.0 mL e.g. about 0.5mL.

[0175] In some embodiments, the compositions disclosed herein are immunogenic composition that, when administered to a subject, induce a humoral and/or cellular antigen-specific immune response (i.e. an immune response which specifically recognizes a naturally occurring HPV polypeptide). For example, an immunogenic composition may induce a memory T and/or B cell population relative to an untreated subject following HPV infection, particularly in those embodiments where the composition comprises a nucleic acid comprising a sequence which encodes HPV antigen or comprises HPV antigen. In some embodiments, the subject is a vertebrate, such as a mammal e.g. a human or a veterinary mammal.

[0176] The compositions of the invention can be formulated as vaccine compositions. The vaccine will comprise an immunologically effective amount of antigen. By "an immunologically effective amount" is intended that the administration of that amount to a subject, either in a single dose or as part of a series, is effective for inducing a measurable immune response against HPV in the subject. This amount varies depending upon the health and physical condition of the individual to be treated, age, the taxonomic group of individual to be treated (e.g. human, non-human primate, etc.), the capacity of the individual's immune system to synthesize antibodies, the degree of protection desired, the formulation of the composition or vaccine, the treating doctor's assessment of the medical situation, the severity of the disease, the potency of the compound administered, the mode of administration, and other relevant factors. It is expected that the amount will fall in a relatively broad range that can be determined through routine trials. Vaccines as disclosed herein may either be prophylactic (i.e. to prevent infection) or therapeutic (i.e. to treat infection), but will typically be therapeutic. In some embodiments, the vaccine compositions disclosed herein may induce an effective immune response against an HPV infection, i.e., a response sufficient for treatment or prevention of HPV infection, such as recurrent HPV. Further uses of immunogenic compositions or vaccines comprising the nucleic acid constructs as described herein are provided herein below.

[0177] A composition of the present disclosure may also comprise, or be administered in conjunction with, one or more adjuvants (e.g. vaccine adjuvants), in particular where the composition comprises an immunologically effective amount of a nucleic acid encoding a HPV antigen. By adjuvant is intended that is capable of increasing an immune response against an antigen compared to administration of said antigen alone. In some aspects, adjuvant compositions as disclosed herein further comprise one or more immunostimulants, for example, a saponin such as QS21.

[0178] Adjuvants which may be used in compositions of the invention include, but are not limited to: (A) Mineral- containing compositions, for example aluminum and calcium salts, such as aluminum phosphates. (B) Oil emulsions, for example squalene-in-water emulsions, such as MF59 or AS03. Complete Freund's adjuvant (CFA) and incomplete Freund's adjuvant (IF A) may also be used. (C) Saponin formulations. (D) Virosomes and virus-like particles (VLPs). (E) Bacterial or microbial derivatives such as non-toxic derivatives of enterobacterial lipopolysaccharide (LPS), Lipid A derivatives, immunostimulatory oligonucleotides and ADP-ribosylating toxins and detoxified derivatives thereof. (F) Human immunomodulators, for example cytokines, such as interleukins, interferons, macrophage colony stimulating factor, and tumor necrosis factor. (G) Bioadhesives and mucoadhesives, such as esterified hyaluronic acid microspheres, cross-linked derivatives of poly(acrylic acid), polyvinyl alcohol, polyvinyl pyrollidone, polysaccharides and carboxymethylcellulose. (H) Microparticles, for example particles of ∼100nm to ∼150µm in diameter, more preferably ∼200nm to ∼30µm in diameter, and most preferably ∼500nm to ∼10 µm in diameter) formed from materials that are biodegradable and non-toxic (e.g. a poly(a-hydroxy acid), a polyhydroxybutyric acid, a polyorthoester, a polyanhydride, a polycaprolactone, etc.), with poly(lactide-co-glycolide) are preferred, optionally treated to have a negatively-charged surface (e.g. with SDS) or a positively-charged surface (e.g. with a cationic detergent, such as CTAB). (I) Liposomes. (J) Polyoxyethylene ether and polyoxyethylene ester formulations. (K) Polyphosphazene (PCPP). (L) Muramyl peptides. (M) Imidazoquinolone compounds, for example Imiquamod and its homologues.

[0179] Combinations of one or more of the adjuvants identified above may also be used with the invention.

Therapeutic RNA vaccine constructs

[0180] Because of the diversity of HPV types that can establish infection and result in LSIL/CIN1 in humans, the RNA based vaccine constructs of the present invention are designed express antigenic Early HPV proteins and/or peptides that induce or boost CD8+ T cells that are reactive to multiple HPV types. Suitably, the antigenic HPV polypeptides also induce a CD4+ T-cell response. The antigenic proteins are selected to induce an immune reaction to specific HPV types; the targeted HPV types are selected based on HPV protein expression patterns and the prevalence of HPV types in human infection, LSIL and CIN1. Accordingly, the vaccine constructs of the present invention are useful in treating a range of HPV-related disease, including persistent HPV infection, LSIL and/or CIN1.

[0181] Thus, the present invention provides RNA construct(s), such as SAM construct(s), comprising a transgene capable of expressing immunogenic peptide(s) derived from HPV proteins. Suitable transgenes are described herein.

[0182] In one embodiment, the recombinant viral vectors of the present invention are designed for use in a therapeutic vaccination program as described herein (see Methods of Use) to treat e.g., HPV infection, LSIL, and/or CIN1, in a human subject in need of treatment thereof. In one embodiment, the RNA viral vector(s) comprise a transgene expressing antigenic peptide fragments from hrHPV early proteins, selected from certain high-risk HPV types, where the peptides are selected or designed to provide cross-reactivity to additional high-risk HPV types.

[0183] In one embodiment the recombinant viral vector(s) of the present invention comprise a transgene encoding antigenic peptide(s) of HPV E1, E2, E6 and/or E7 polypeptides from hrHPV types. In another embodiment of the present invention, the nucleotide sequence is capable of expressing HPV E2 and E6 antigenic peptides from hrHPV types; in another embodiment the nucleotide sequence is capable of expressing E1 and E7 antigenic peptides from hrHPV types. In another embodiment the nucleotide sequence is capable of expressing antigenic peptides from any two, three or four of HPV E1, E2, E6, and E7 proteins, where the proteins are from hrHPV types.

[0184] More specifically, in one embodiment the present invention provides RNA viral vector(s) wherein

• a first RNA vector expresses antigenic peptides from E1 of hrHPV types 16 and 18 and antigenic peptides from E6 proteins of hrHPV types 16, 18, 31, 33, 45, 52 and 58;
• a second RNA vector expresses antigenic peptides from E2 of hrHPV types 16, 18, 31 and 33; and
• a third RNA vector expresses antigenic peptides from E7 of hrHPV types 16 and 18 and antigenic peptides from E2 proteins of hrHPV types 45, 52 and 58.

[0185] The transgene may further comprises a peptide or non-peptide linker located between adjacent HPV sequences, or a sequence that induces separate translation of the adjacent HPV sequences (such as the 2A ribosomal skipping sequence described herein).

Methods of use

[0186] The RNA constructs of the present invention are useful as therapeutic vaccines, to treat persistant HPV infection or subclinical HPV infection of the human anogenital epithelium, such as cervical epithelium, or HPV-related conditions such as CIN1 or LSIL, in a subject in need of such treatment. Suitable subjects include humans.

[0187] In treating human subjects, a self-replicating RNA molecule provides an efficient delivery vehicle that can deliver a selected transgene to a selected host cell in vivo. In one embodiment, the nucleic acid- based constructs and the cells are mixed ex vivo; the transfected cells are cultured using conventional methodologies; and the transduced cells are re-introduced into the patient. These techniques are suited to transgene delivery for therapeutic purposes and for immunization.

[0188] The RNA constructs comprising HPV transgenes may be administered in immunogenic compositions. An immunogenic composition as described herein is a composition comprising one or more RNA constructs capable of inducing an immune response, for example a humoral (e.g., antibody) and/or cell-mediated (e.g., a cytotoxic T cell) response(s), against a transgene product delivered by the vector following delivery to a mammal, suitably a human. RNA constructs comprising transgenes encoding selected hrHPV antigenic peptide(s), as described herein, are therefore suitable for use in a therapeutic vaccine to treat HPV infection or HPV-related disease.

[0189] Accordingly, in one embodiment the present invention provides RNA constructs, such as SAM constructs, for use in the treatment HPV infection or HPV-related disease, including HPV-related lesions staged or diagnosed as CIN1 or LSIL.

[0190] In further embodiments, the present invention provides the use of one or more RNA construct(s) according to the present invention in the manufacture of a medicament for the generation of an immune response against HPV. Thus, the present invention provides the use of one or more RNA construct(s) comprising an expression cassette comprising a transgene encoding immunogenic peptides derived from hrHPV, as described herein, in the manufacture of a medicament for the treatment of HPV infection or associated disease.

[0191] In one embodiment the present invention provides a method of treating infection or disease caused by HPV, comprising the administration of an effective amount of one or more RNA construct(s) comprising an expression cassette comprising a transgene encoding immunogenic peptides derived from hrHPV, as described herein. In one embodiment the present invention provides a method of generating or enhancing an immune response directed against HPV, comprising the administration of one or more RNA construct(s) according to the present invention. Particularly, the method of generating or enhancing an immune response comprises the administration of an effective amount of one or more SAM construct(s) comprising a transgene encoding at least two antigenic HPV polypeptides from a first HPV early protein, such as E1, where the antigenic HPV polypeptides are from different high-risk HPV types (e.g., an antigenic polypeptide from HPV16 E1 and an antigenic polypeptide from HPV18 E1), and where the antigenic polypeptides share at least 70% amino acid sequence identity with an additional high-risk HPV type (where the transgene does not encode antigenic polypeptides from that additional high-risk HPV type). The transgene typically further encodes at least two antigenic HPV polypeptides from a second HPV early protein, such as E2 or E6, where the antigenic HPV polypeptides are from different high-risk HPV types (e.g., an antigenic polypeptide from HPV16 E2 or HPV16 E6 and an antigenic polypeptide from HPV18 E2 or HPV18 E6), and where the antigenic polypeptides share at least 70% amino acid sequence identity with an additional high-risk HPV type (e.g., HPV35), though the transgene does not encode antigenic polypeptides from that additional high-risk HPV type. Additionally, the antigenic polypeptides may be selected to include at least one T cell epitope.

[0192] Such vaccines or other immunogenic compositions may be formulated in a suitable delivery vehicle. Generally, doses for the immunogenic compositions are in the range defined below under 'Delivery Methods and Dosage'. The levels of immunity (humoral and/or cell based) to the selected peptide(s) can be monitored to determine the need, if any, for subsequent (booster) immunizations. Following an assessment of antibody titers in the serum, optional booster immunizations may be administered.

[0193] The RNA constructs are administered in an immunogenic amount, that is, an amount of recombinant adenovirus that is effective in a route of administration to transfect the desired target cells and provide sufficient levels of expression of the selected polynucleotide sequences to induce an effective immune response. As used herein, an effective immune response is one resulting in a therapeutic effect.

[0194] The RNA constructs described herein are expected to be efficacious at inducing cytolytic T cells directed to the HPV antigenic protein(s) expressed by the vector.

[0195] It will be apparent to one skilled in the art that the use of certain sequences in the transgene, between the HPV sequences, will result in the addition of amino acids to the HPV antigenic sequence. Use of the '2A' sequence as described herein between (in 5' to 3' direction) a nucleotide sequence encoding a first HPV peptide and a nucleotide sequence encoding a second HPV peptide results in the addition of amino acids 1-23 of SEQ ID NO:36 to the first expressed HPV peptide, and addition of a Proline residue to the second expressed HPV peptide.

Administration Regimens

[0196] It will be readily understood that the RNA constructs of the invention are suited for use in regimens involving repeated delivery of HPV immunogenic peptide(s) over time for therapeutic purposes. The regimens may involve multiple delivery of the same transgene(s) or a delivery over time of different transgenes. These regimens may deliver the same or different therapeutic immunogenic HPV peptide(s). These regimens are not limited to delivery of RNA constructs but can utilize other types of nucleic acid vectors such as adenoviral vectors, eg. non-human primate adenoviral sequences or human adenoviral sequences, in combination with the RNA constructs.

[0197] "Simultaneous" administration refers to administration in a time period such that the simultaneously administered components contribute to the same ongoing immune response, e.g., the components are administered at the same time (e.g., co-formulated into a unitary dose, or admixed just prior to administration to the subject) or delivered in separate formulations in a limited time frame (e.g., a single day, hour, or fraction of an hour). Simultaneous administration is also referred to as co-administration. In some embodiments, co-administration may involve administration of one or more RNA construct(s) and administration of a protein component, which may be an adjuvanted protein composition.

[0198] A prime-boost regimen may be used in the methods of the present invention. Prime-boost refers to eliciting two separate immune responses in the same individual: (i) an initial priming of the immune system followed by (ii) a secondary or boosting of the immune system weeks or months after the primary immune response has been established.

Delivery Methods and Dosage

[0199] The compositions disclosed herein are for use in a method for inducing a cross-reactive immune response against hrHPVs of at least three different hrHPV types in a mammalian subject, the method comprising administering to a subject in need of treatment an immunologically effective amount of the compositions as provided herein.

[0200] In some embodiments, a composition comprising the recombinant adenovirus of the invention is administered to a subject by intramuscular injection, intravaginal injection, intravenous injection, intraperitoneal injection, subcutaneous injection, epicutaneous administration, intradermal administration, nasal administration or oral administration.

[0201] Because RNA constructs may be limited in the size of the transgene that they can effectively carry and express, in one embodiment the therapeutic method of the present invention comprises the administration of two or more RNA constructs carrying different transgenes, in order to achieve sufficient expression of multiple HPV antigenic peptides in the subject. Alternatively, the different transgenes may express antigenic peptides from the same HPV Early proteins, but from different hrHPV types.

[0202] In one embodiment, the therapeutic method of the present invention comprises the administration of three SAM vectors, wherein:

• a first SAM vector may express antigenic peptides from E1 of hrHPV types 16 and 18 and antigenic peptides from E6 proteins of hrHPV types 16, 18, 31, 33, 45, 52 and 58;
• a second SAM vector may express antigenic peptides from E2 of hrHPV types 16, 18, 31 and 33; and
• a third SAM vector may express antigenic peptides from E7 of hrHPV types 16 and 18 and antigenic peptides from E2 proteins of hrHPV types 45, 52 and 58.

[0203] If the therapeutic regimen involves co-administration of more than one RNA construct, the RNA constructs may be co-formulated in a single unit dose. Where vectors are formulated in different compositions, they may be administered co-locationally at or near the same site. For example, the components can be administered to a subject (e.g. via an administration route selected from intramuscular, transdermal, intradermal, sub-cutaneous) to the same side or extremity ("co-lateral" administration) or to opposite sides or extremities ("contra-lateral" administration).

[0204] Dosages of the RNA construct will depend primarily on factors such as the route of administration, the condition being treated, the age, weight and health of the patient, and may thus vary among patients. Generally a human dose will be in a volume of between 0.1ml and 2 ml. Thus the composition described herein can be formulated in a volume of, for example, about 0.1, 0.15, 0.2, 0.5, 1.0, 1.5 or 2.0 ml human dose per individual or combined immunogenic components.

[0205] One of skill in the art may adjust these doses, depending on the route of administration and the subject being treated.

[0206] The therapeutic immune response against the protein encoded by the selected transgene can be monitored to determine the need, if any, for boosters. Following an assessment of the immune response (e.g., of CD4+/CD8+ T cell response, antibody titers, in the serum, or both), optional booster immunizations may be administered.

[0207] The present invention will now be further described by means of the following non-limiting examples.

EXAMPLES

Example 1 - Antigen Design to target 7 hrHPV types

[0208] Investigations were carried out to identify HPV antigens capable of eliciting an immunogenic response to at least seven of fifteen high risk HPV types, and to prepare adenoviral constructs capable of expressing the antigens. The amino acid sequences of E1, E2, E6 and E7 proteins from fifteen hrHPV types were compared, and regions of high similarity that contained CD4/CD8 epitopes were identified. Antigenic regions were selected to target seven hrHPV types: 16, 18, 31, 33, 45, 52, and 58.

[0209] Table 1 and Table 2 illustrate that, for each of the proteins studied, combinations of conserved sequences from certain HPV types provided a minimum 70% identity or 70% similarity to other HPV types (for that protein). In Tables 1 and 2, for each protein (E1, E2, E6 or E7), shaded squares indicate the HPV type from which a sequence was selected; the percent identity or similarity to other HPV types that is provided by the selected sequences is indicated in the other squares of the column (blank squares indicate less than 70% similarity or identity; n/d indicates not done).

Table 1 - Identity Threshold 70%
	E1	E2	E6	E7
HPV16
HPV18
HPV31	79%			72%
HPV33
HPV45	89%			78%
HPV52	79%
HPV58	90%
HPV56
HPV51
HPV39	80%
HPV35	78%	73%	72%	72%
HPV59	81%
HPV68	80%
HPV73
HPV82

Table 2 - Similarity Threshold 70%
E1	E2	E6	E7
90%			n/d
			n/d
95%			n/d
92%			n/d
96%			n/d
81%		73%	n/d
80%		74%	n/d
89%	74%	78%	n/d
90%	81%	81%	n/d
93%	76%	76%	n/d
90%	74%	79%	n/d
83%	71%	74%	n/d
79%		72%	n/d

[0210] Regions of HPV E1, E2, E6 and E7 were identified for inclusion:

E1 = aa203-622: The E1 constructs from HPV 16 and 18 contained aa203-622, (numbering corresponds to full length HPV 16 E1 (SEQ ID NO:14)). See SEQ ID NO:18 (HPV16 E1 construct), SEQ ID NO:19 (HPV18 E1 construct).

E2 = aa1-201 + GGTGGS + aa285-365 : The E2 constructs from HPV 16, 18, 31, 33, 45, 52 and 58 contained a TAD segment (amino acids corresponding to aa1-201 of full-length HPV16 E2 (SEQ ID NO:40)), a GGTGGS linker, and a DBD domain segment (amino acids corresponding to aa285-365 of full-length HPV16 E2 (SEQ ID NO:15). See SEQ ID NO:20 (HPV16 E2 construct), SEQ ID NO: 21 (HPV18 E2 construct), SEQ ID NO:22 (HPV31 E2 construct), SEQ ID NO:23 (HPV33 E2 construct), SEQ ID NO:24 (HPV45 E2 construct), SEQ ID NO:25 (HPV52 E2 construct), and SEQ ID NO:26 (HPV58 E2 construct).

E6 = aa11-150: The E6 constructs from HPV 16, 18, 31, 33, 45, 52 and 58 contained amino acids 11-150 (numbering based on HPV16 E6 full length, SEQ ID NO:16). See SEQ ID NO:27 (HPV16 E6 construct), SEQ ID NO:28 (HPV18 E6 construct), SEQ ID NO:29 (HPV31 E6 construct), SEQ ID NO:30 (HPV33 E6 construct), SEQ ID NO:31 (HPV45 E6 construct), SEQ ID NO:32 (HPV52 E6 construct), and SEQ ID NO:33 (HPV58 E6 construct).

E7 = aa49-98 and aa7-28, with fragment aa49-98 placed N-terminal to aa7-28, and with C24G and E26Q substitutions: The E7 construct comprises aa49-98 and aa7-28, with fragment aa49-98 placed N-terminal to aa7-28. (Numbering corresponds to HPV 16 E7 (SEQ ID NO:17)). See_SEQ ID NO: 34 (HPV16 E7 construct) and SEQ ID NO:35 (HPV18 E7 construct).

[0211] Nucleotide insert constructs Gly_E2⁴, Gly_E2³E7² and Gly_E1²E6⁷, as shown in Table 3, were generated. "Gly" indicates that a nucleotide sequence encoding a 5xGly linker (SEQ ID NO:37) was placed between adjacent HPV-encoding sequences in the construct. These constructs are shown schematically in Figure 1, where the triple vertical lines indicate the presence the 5xGly linker.

[0212] The following mutations were introduced into these inserts to eliminate the native activity of the wild-type E1, E2, E6 and E7 proteins:

• E1 = 203-622 + mut G482D;
• E2 = 1-201 + GGTGGS + 285-365 + mut K111A;
• E6 = 11-150 + mut C110R and mut F54R;
• E7 HPV16 = 49-98 + 7-28 + mutations C24G and E26Q / E7 HPV18 = 58-105 + 7-42 + mutations C27G and E29Q.E1 = 203-622 + mut G482D.

Table 3A - E2 and E2E7 inserts

Insert Identifier1	E2	E7
Gly_E24 SEQ ID NO: 2 Fig. 2A	HPV16 (SEQ ID NO:20)
	HPV18 (SEQ ID NO:21)
	HPV31 (SEQ ID NO:22)
	HPV33 (SEQ ID NO:23)
Gly_E2"E72 SEQ ID NO: 4 Fig. 2B	HPV45 (SEQ ID NO:24)	HPV16 (SEQ ID NO:34)
	HPV52 (SEQ ID NO:25)	HPV18 (SEQ ID NO:35)
	HPV58 (SEQ ID NO:26)

(1) superscript numbers in construct identifiers indicate the number of HPV types; "Gly" indicates a 5xGly linker was placed between HPV antigenic peptides in the construct.

Table 3B - E1E6 inserts

Insert Identifier1	E1	E6
Gly_E12E67 SEQ ID NO: 6 Fig. 2C	HPV16 (SEQ ID NO:18)	HPV16 (SEQ ID NO:27)
	HPV18 (SEQ ID NO:19)	HPV18 (SEQ ID NO:28)
		HPV31 (SEQ ID NO:29)
		HPV33 (SEQ ID NO:30)
		HPV45 (SEQ ID NO:31)
		HPV52 (SEQ ID NO:32)
		HPV58 (SEQ ID NO:33)

(1) superscript numbers in construct identifiers indicate the number of HPV types; "Gly" indicates a 5xGly linker was placed between HPV antigenic peptides in the construct.

Example 2 - Design of SAM constructs encoding antigenic HPV polypeptides

[0213] The SAM platform is based on synthetic, self-amplifying mRNA derived from the alphavirus genome, expressing antigens of interest. The SAM constructs are evaluated for robust antigen productions and antigenicity and further tested for their immunogenicity and efficacy using in vivo models.

[0214] The design of the HPV-SAM constructs of Fig. 2 includes cloning the sequence encoding the antigenic HPV peptides, under the subgenomic promoter in the SAM vector. Modifications to the SAM HPV constructs were made including codon optimisation of the coding sequence for the antigen.

[0215] The SAM vector VEE TC-83 as described in WO2005/113782 was used as the background construct for cloning. This background construct has the nucleic acid sequence of SEQ ID NO: 1.

[0216] Gly_E2⁴, Gly_E2³E7² and Gly_E1²E6⁷ were then cloned into SAM constructs (one construct for each insert) after nucleotide 7561 of SEQ ID NO:1.

[0217] SAM constructs having the sequence of SEQ ID NO: 9, SEQ ID NO: 11 and SEQ ID NO:13 have been designed and obtained.

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Claims

1. One or more RNA construct(s) comprising nucleic acid sequences encoding:

(1) antigenic Human Papillomavirus (HPV) polypeptides from a first HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type, and

(2) antigenic HPV polypeptides from a second HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity with at least one additional high-risk HPV type,

and wherein each of said antigenic HPV polypeptides includes at least one T cell epitope, and said nucleic acid sequences are operatively linked to one or more sequences which direct expression of said antigenic HPV polypeptides in a mammalian host cell.

2. The RNA construct(s) according to claim 1, which do not comprise any nucleic acid sequence encoding an antigenic polypeptide from an HPV Late 1 (L1) protein or an HPV Late 2 (L2) protein.

3. The RNA construct(s) according to claim 1 or 2, wherein the nucleic acid sequences express separate antigenic HPV polypeptides.

4. The RNA construct(s) according to claim 1 or 2, wherein the nucleic acid sequences express antigenic HPV polypeptides that are linked by a peptide linker.

5. The RNA construct(s) according to any one of claims 1 to 4 wherein the nucleic acid sequences expressing antigenic HPV polypeptides from the first and second HPV early protein are located on the same RNA construct.

6. The RNA construct(s) according to any one of claims 1 to 4 wherein the nucleic acid sequences expressing antigenic HPV polypeptides from the first and second HPV early protein are located on two or more RNA constructs.

7. The RNA construct(s) according to any one of claims 1 to 6, comprising antigenic polypeptide sequences selected from HPV types HPV16, HPV18, HPV31, HPV33, HPV35, HPV39, HPV45, HPV51, HPV52, HPV56, HPV58, HPV59, HPV68, HPV73 and HPV82.

8. The RNA construct(s) according to any one of claims 1 to 7, wherein:

(a) said first HPV early protein is Early 1 (E1), and said second HPV early protein is selected from Early 2 (E2), Early 6 (E6), and Early 7 (E7);

(b) said first HPV early protein is E2, and said second HPV early protein is selected from E1, E6 and E7;

(c) said first HPV early protein is E6, and said second HPV early protein is selected from E1, E2 and E7; or

(d) said first HPV early protein is E7, and said second HPV early protein is selected from E1, E2 and E6.

9. The RNA construct(s) according to any one of claims 1 to 8, wherein said first HPV early protein is Early 1 (E1), and wherein said antigenic HPV polypeptides from E1 include antigenic polypetides from HPV16 E1 and HPV18 E1.

10. The RNA construct(s) according to any one of claim 1 to 9, further comprising a nucleic acid sequence encoding antigenic HPV polypeptides from a third HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity, and each antigenic HPV polypeptide includes at least one T cell epitope, and wherein said first HPV early protein is E1, said second HPV early protein is E2 and said third HPV early protein is E6.

11. The RNA construct(s) according to claim 10, comprising nucleic acid sequences encoding antigenic polypeptides from HPV16 E1, HPV18 E1, HPV16 E2, HPV18 E2, HPV16 E6 and HPV18 E6.

12. The RNA construct(s) according to claim 10 or 11, further comprising a nucleic acid sequence encoding antigenic HPV polypeptides from a fourth HPV early protein, where said antigenic HPV polypeptides are from at least two different high-risk HPV types, and share at least 70% amino acid sequence identity, and each antigenic HPV polypeptide sequence includes at least one T cell epitope, and wherein said first HPV early protein is E1, said second HPV early protein is E2, said third HPV early protein is E6 and said fourth HPV early protein is E7.

13. The RNA construct(s) according to claim 12, comprising nucleic acid sequences encoding antigenic polypeptides from HPV16 E1, HPV18 E1, HPV16 E2, HPV18 E2, HPV16 E6, HPV18 E6, HPV16 E7 and HPV18 E7.

14. The RNA construct(s) according to claim 11 or 13, further comprising nucleic acid sequences encoding antigenic polypeptides from HPV31 E2, HPV33 E2, HPV45 E2, HPV52 E2, HPV58 E2, HPV31 E6, HPV33 E6, HPV45 E6, HPV52 E6, HPV52 E6 and HPV58 E6.

15. The RNA construct(s) according to any one of claim 1 to 14, wherein the nucleic acid sequence encodes a polypeptide that is at least 90%, 92%, 95%, 97%, 98%, 99% or 100% identical to a sequence selected from the group consisting of SEQ ID NO2, SEQ ID NO:4 and SEQ ID NO:6.

16. A self-replicating RNA molecule comprising the RNA construct(s) of any of claims 1 to 15.

17. A DNA molecule encoding the RNA construct(s) of any of claims 1 to 15 or the self-replicating RNA molecule of claim 16.

18. A vector comprising the RNA construct(s) of any of claims 1 to 15, the self-replicating RNA molecule of claim 16 or the DNA molecule of claim 17.

19. An immunogenic composition comprising the RNA construct(s) of any of claims 1 to 15, the self-replicating RNA molecule of claim 16, the DNA molecule of claim 17 or the vector of claim 18 and a pharmaceutically acceptable carrier.

20. The immunogenic composition according to claim 19, wherein the composition comprises a non-viral delivery material, such as a submicron cationic oil-in-water emulsion; a liposome; or a biodegradable polymeric microparticle delivery system.

21. The immunogenic composition according to claim 19 or 20, wherein the composition comprises one or more adjuvants.

22. The RNA construct(s) of any of claims 1 to 15, the self-replicating RNA molecule of claim 16, the DNA molecule of claim 17, the vector of claim 18 or the immunogenic composition of claim 19, 20 or 21, for use in therapy.

23. The RNA construct(s) of any of claims 1 to 15, the self-replicating RNA molecule of claim 16, the DNA molecule of claim 17, the vector of claim 18 or the immunogenic composition of claim 19, 20 or 21, for use in the treatment of an HPV-related condition of the human anogenital tract, selected from infection by HPV such as a high-risk HPV type, and, lesions of the cervical epithelium, such as Cervical Intraepithelial Neoplasia grade 1 (CIN1) and low-grade squamous intraepithelial lesions (LSIL).

Drawing